Laparoscopic Ventral Hernia Repair with Poly-4-Hydroxybutyrate Absorbable Barrier Composite Mesh

Abstract

Background: Repair of ventral and incisional hernias (VIHR) is a common procedure, newly introduced resorbable mesh biomaterials provide an attractive option to reduce the use of permanent synthetic mesh in hernia surgery and reduce its complications. However, data on the use of slowly resorbable mesh materials remains scarce, this study aims to evaluate the use of poly-4hydroxybutyrate/absorbable barrier composite mesh (P4HB/ABCM) in laparoscopic repair of VIHR.Methods: This is a retrospective study of a sequential cohort of patients undergoing laparoscopic VIHR utilizing a P4HB/ABCM mesh. Perioperative characteristics and clinical outcomes were collected.Results: In total, 26 patients including 10 females and 7 males underwent laparoscopic VIHR using P4HB/ABCM. All surgeries were performed in a single institution by the same surgeon. The average patient age was 52.6, and the mean BMI was 35.5. All patients had a clean wound classification. The average defect size was 136.4 cm 2 . All patients were seen in clinic with a median follow-up of 28 months.We observed 4 wound seromas, and no wound infections or recurrences during the follow-up period. Conclusion:Results of laparoscopic VIHR with P4HB/ ABCM are favorable and encourages further studies on the role of absorbable biosynthetic mesh materials in hernia surgery.

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 ).…”

“…Most of the general surgery studies identified by this literature review ( n = 31/40; 78%) utilized P4HB mesh in the repair of ventral/incisional hernias, primarily at the midline ( Table 1 and Table 3 ) ( 12 , 30 , 31 , 50 – 53 , 55 , 59 , 60 , 62 , 63 , 65 – 78 , 81 – 85 ). Primary fascial closure was planned in all cases, with definitive repair as the goal.…”

“…It should be noted that clinical outcomes were evaluated in patients along the entire continuum of Centers for Disease Control (CDC) wound classes ( 33 ) and Ventral Hernia Working Group (VHWG) grades ( 34 , 35 ), ranging from clean cases at low risk of postoperative complications to contaminated/dirty cases at high risk of postoperative complications ( Table 4 ). Systematic reviews ( 59 ), commentaries ( 86 ), and clinical studies of CDC Class I (clean) cases only ( 51 , 65 ) comprised a small number of articles, with the majority of the identified clinical studies describing complex cases with elevated CDC wound class or comorbidities placing patients at high risk of postoperative complications ( n = 13) ( 12 , 30 , 31 , 50 , 52 , 55 , 60 , 62 , 71 , 75 , 76 , 83 , 85 ) or “off-label” use of P4HB mesh to repair ventral/incisional hernias in potentially contaminated or contaminated fields ( n = 15) ( 11 , 53 , 63 , 66 – 70 , 72 – 74 , 77 , 78 , 81 , 82 , 84 ). After a thorough evaluation of the clinical studies identified by this scoping review, several major themes emerged, namely: (1) P4HB mesh provides long-term strength at the repair site, leading to acceptable rates of recurrence as compared to higher-risk cohorts and those repaired with non-synthetic biomaterials ( 30 , 31 , 66 , 70 , 75 , 76 ); (2) P4HB mesh performs favorably in contaminated settings where permanent synthetic mesh use may be higher risk or contraindicated, resulting in low incidence of surgical site infection (SSI) ( 70 , 76 , 90 ); and (3) P4HB mesh represents an alternative for ventral/incisional hernia repair relative to biologic meshes and when permanent synthetic mesh complications are taken into consideration ( 30 , 69 ).…”