Biosynthetic Versus Synthetic Mesh in Oncologic Ventral Hernia Repair

Ventral hernia repair in oncologic patients is challenging due to poor tissue quality, immunosuppression, malnutrition, and prior operations. Limited data exists comparing the outcomes of biosynthetic (Poly-4-hydroxybutyrate) and synthetic mesh in this population. This study aims to assess the outcomes in patients who undergo hernia repair using one of two mesh types.

Patients undergoing ventral hernia repair by the Plastic and Reconstructive Surgery service and general surgery after oncologic resection from 2010 to 2023 were included, with patient records reviewed and cases identified in a prospectively maintained database by the Plastic and Reconstructive Service. Repairs were done in a retrorectus, underlay, or onlay fashion with either biosynthetic or synthetic mesh. Primary endpoints included complication rates (hematoma, infection/cellulitis, wound dehiscence, abscess, seroma) and hernia recurrence.

207 patients underwent repair (102 biosynthetic, 105 synthetic) and were included. Baseline demographics were similar between groups. No significant difference was observed in complication rates (biosynthetic: 24%, synthetic: 18%; p=0.3). Hernia recurrence was noted in 8.8% of biosynthetic and 6.7% of synthetic mesh cases (p>0.6). Subgroup analysis of wound classes II-IV showed consistent results. Up to two years postoperatively, synthetic mesh did not significantly reduce hernia recurrence risk compared to biosynthetic mesh (Subdistribution Hazard Ratio (sHR): 0.66; 95% CI, 0.27-1.59; p=0.4). Bilateral external abdominal oblique release (sHR: 0.31; 95% CI, 0.11-0.87, p=0.026) and retromuscular mesh placement (sHR: 0.08; 95% CI, 0.02, 0.35, p<0.001) exhibited a protective role.

Biosynthetic mesh can be considered a reasonable alternative to synthetic mesh in this high-risk population.