Evaluation of Absorbable Mesh for Prophylactic Mesh Augmentation in High-Risk Patients

Abstract

Purpose: Hernia prevention following abdominal surgery has become a subject of growing interest in general surgery. Prophylactic mesh augmentation (PMA) is an emerging technique to prevent incisional hernia in high-risk populations. The aim of this study was to determine the efficacy and safety of PMA using an absorbable mesh. Methods: A retrospective review was performed on patients who underwent PMA between July 2014 and March 2020. A prophylactic synthetic absorbable mesh (Phasix™; Becton Dickinson, Franklin Lakes, NJ) was placed at the surgeon’s discretion according to the indication for the primary operation. The primary outcome was the incisional hernia rate. Secondary outcomes included mesh-related or other complications. Results: Fifty patients underwent PMA following cystectomy with ileal conduit, open aortic surgery, or colostomy creation/takedown. Overall, 10 patients (20%) developed hernia at a median follow-up of 2.2 years. Six of these 10 hernias occurred at incisions where mesh was not placed. There were no documented mesh infections. One mesh (2%) in the AAA group was explanted due to an infected endograft, but there was no evidence of mesh complication. Two patients (4%) developed seroma. Two (4%) patients developed superficial surgical site infections (SSI). There were no documented deep-space SSI. Conclusion: PMA is an emerging technique with a low rate of incisional hernia in high-risk patients, such as those undergoing stoma creation or open aortic intervention. The use of an absorbable mesh seems promising, however more and longer-term research is needed.

Fully resorbable poly-4-hydroxybutyrate (P4HB) mesh for soft tissue repair and reconstruction: A scoping review

“…The majority of the identified publications ( n = 50/79; 63%) involved clinical studies describing the use of P4HB mesh in plastic and reconstructive surgery ( n = 10) ( 13 – 15 , 18 – 21 , 56 , 61 , 64 ) or general surgery applications ( n = 40) ( 11 , 12 , 27 – 31 , 50 – 55 , 57 – 60 , 62 , 63 , 65 – 85 ) as shown in Figure 2 , and Table 1 . In the area of plastic and reconstructive surgery, P4HB meshes have been utilized primarily in cosmetic breast applications ( 21 ) including mastopexy/reduction mammaplasty ( 18 , 19 ), prevention of bulge at the donor site on the abdominal wall ( 14 , 64 ), support of the lower pole ( 13 , 20 , 56 ), tissue expander-based reconstruction ( 15 ), and 3-D mesh breast reconstruction with autologous fat grafting ( 61 ).…”

“…P4HB meshes have been utilized extensively in general surgery for a wide variety of hernia repair and abdominal wall reconstruction applications ( 11 , 12 , 27 – 31 , 50 – 55 , 57 – 60 , 62 , 63 , 65 – 85 ). A small number of studies ( n = 2 in each group) evaluated P4HB mesh for incisional hernia prophylaxis ( 27 , 54 ) and inguinal hernia repair ( Table 1 , and Table 2 ) ( 11 , 28 ). Several studies ( n = 5) also explored the use of P4HB mesh in hiatal/paraesophageal hernia repair ( Table 1 , and Table 2 ) ( 29 , 57 , 58 , 79 , 80 ).…”

“…P4HB mesh has also been evaluated as a potential biomaterial for the repair of pelvic organ prolapse in urogynecological surgery ( 23 – 26 ). The majority of data and clinical research using P4HB mesh has focused on general surgery applications, particularly in the area of hernia repair (i.e., ventral/incisional hernia, incisional hernia prophylaxis, inguinal hernia, and hiatal/paraesophageal hernia) ( 27 – 31 ). The objective of the current study was to review the results of all peer-reviewed studies involving P4HB mesh, guided by the following research questions: How has P4HB mesh been evaluated to date (i.e., benchtop, preclinical, and clinical peer-reviewed studies)?…”