Long-Term Outcomes After Slowly Resorbable P4HB Mesh Implantation: A Multicenter Analysis From European Registry.
Rudolf van den Berg1, Marie Wieser2, Manuel López-Cano3
1Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
World Journal of Surgery
|March 20, 2026
Summary
Poly-4-hydroxybutyrate (P4HB) mesh shows good long-term safety for incisional hernia repair after resorption. While mesh complications are low, hernia recurrence is influenced by patient factors and surgical approach.
Area of Science:
- Biomaterials Science
- Surgical Innovation
- Hernia Repair Techniques
Background:
- Fully resorbable poly-4-hydroxybutyrate (P4HB) mesh is used for incisional hernia repair.
- Limited long-term data exists post-mesh resorption.
Purpose of the Study:
- Evaluate long-term safety and efficacy of P4HB mesh in incisional hernia repair.
- Assess complications and recurrence rates after mesh resorption.
Main Methods:
- Multicenter European registry analysis of 790 patients undergoing incisional hernia repair with P4HB mesh.
- Stratification by Ventral Hernia Working Group (VHWG) classification.
- Primary endpoint: long-term mesh-related complications (1-5 years post-implantation).
Main Results:
- Low long-term mesh morbidity: infection (2%), chronic pain (3-5%) post-resorption.
- Hernia recurrence rate was 22%, influenced by VHWG grade, obesity, and mesh placement.
- Complication risk increased with higher ASA class.
Conclusions:
- P4HB mesh offers a favorable long-term safety profile post-resorption.
- Hernia recurrence is a significant outcome influenced by patient risk and surgical technique.
- Supports a tailored, risk-stratified approach for biosynthetic mesh use in incisional hernia repair.
