PVDF versus polypropylene large pore mesh for open incisional hernia repair - a case control matched analysis

PURPOSE: Several types of compound plastics are used in the fabrication of surgical mesh, influencing the specific tissue response to mesh fibers and thus the suitability of the mesh. Experimental data suggests that polyvinylidene fluoride (PVDF) seems more resistant to hydrolysis and degradation compared to polyethylene-terephthalate (PET) or polypropylene (PP) and there might be an improved biocompatibility compared to PP, while ageing does not increase stiffness. Although PVDF has been introduced in abdominal wall repair since years, the clinical data for its use in retromuscular ventral and incisional hernia repair are scarce, as are data on outcome after longterm follow-up. METHODS: Patients having an open, elective incisional hernia repair at our tertiary academic center from 2014 to 2021, with retromuscular implantation of a large-pore PP mesh (n = 108, PP-group) and 109 patients using a large-pore PVDF mesh (PVDF-group) were matched based on BMI, number of comorbidities, number of risk factors and hernia width resulting in a total of 98 matched patients. Four years follow-up and complications from Clavien-Dindo class IIIa on were collected according to the EHS guidelines. (Trial number: B670201734087) RESULTS: In the matched cohort, 77.6% of patients in the PVDF-group and 79.6% in the PP-group had no grade IIIa to IVb complications during the total follow-up time (p = 0.806). 16.3% of the patients in both the PVDF-group and the PP-group had a SSO. Only 2% in the PP-group versus 4.1% of the patients in the PVDF-group had a SSI (p = 1.00). The most observed complication was seroma with an overall prevalence in 8.2% of patients in both the PVDF-group and PP-group. After 4 years of follow-up only 1 patient with PVDF-mesh had a hernia recurrence requiring surgical intervention, appearing within one month after hospital discharge. CONCLUSION: PVDF meshes show both long-term safety and efficacy. Considering recurrence rate and complications requiring surgical interventions, large pore PVDF-meshes as well as PP-meshes show excellent results. Mostly, hernia size and extensive surgical dissection seem to influence complication rate. Future research should focus more on patient reported outcomes, quality of life and pain scores by large multi-center trials or registry data.