Bio-resorbable poly-4-hydroxybutyrate (P4HB) mesh for abdominal wall reconstruction is effective in high-risk...

Abdominal wall reconstruction in patients with high-risk comorbidities and contamination is controversial. There is no standardized mesh choice for such clinical circumstances. We reviewed our experience of poly-4-hydroxybutyrate (P4HB) mesh for abdominal wall reconstruction in hostile abdomen after emergency and elective abdominal surgeries.

We performed a retrospective review of 48 patients with CDC class 3 or 4 contamination and high-risk comorbidities who underwent abdominal wall reconstruction with P4HB between June 2016-October 2019. Data collected included demographics, abdominal closure techniques, and long-term surgical site complications and hernia recurrence.

Patients ranged from 33-88 years old; 70% were female. BMI ranged from 14-70 kg/m² (mean 36, SD ± 11.31). High-risk comorbidities were present in 75% of patients. Emergency abdominal closures were performed in 69% of patients. Underlay Phasix™ ST mesh was used in 71% of emergency and 53% of elective abdominal closures. Myofascial release was required in 21% of elective and 9% of emergency patients. Fascial negative pressure wound therapy was used in 45% of emergency and 20% of elective patients. Surgical site occurrences were seen in 42% of emergency and 53% of elective abdominal closures. At a mean follow-up of 41.8 months, hernias had recurred in 16% patients after emergency and 20% after elective procedures.

P4HB mesh is well tolerated and provides durable abdominal wall reconstruction with acceptable hernia recurrence after emergency and elective abdominal closure, making it a sensible option for abdominal closure in high-risk comorbidities and abdominal contamination.