Multicenter, Prospective, Longitudinal Study of the Recurrence, Surgical Site Infection, and Quality of Life After Contaminated Ventral Hernia Repair Using Biosynthetic Absorbable Mesh

Abstract

Objective:The aim of the study was to evaluate biosynthetic absorbable mesh in single-staged contaminated (Centers for Disease Control class II and III) ventral hernia (CVH) repair over 24 months.Background:CVH has an increased risk of postoperative infection. CVH repair with synthetic or biologic meshes has reported chronic biomaterial infections and high hernia recurrence rates.Methods:Patients with a contaminated or clean-contaminated operative field and a hernia defect at least 9 cm2 had a biosynthetic mesh (open, sublay, retrorectus, or intraperitoneal) repair with fascial closure (n = 104). Endpoints included overall Kaplan-Meier estimates for hernia recurrence and postoperative wound infection rates at 24 months, and the EQ-5D and Short Form 12 Health Survey (SF-12). Analyses were conducted on the intent-to-treat population, and health outcome measures evaluated using paired t tests.Results:Patients had a mean age of 58 years, body mass index of 28 kg/m2, 77% had contaminated wounds, and 84% completed 24-months follow-up. Concomitant procedures included fistula takedown (n = 24) or removal of infected previously placed mesh (n = 29). Hernia recurrence rate was 17% (n = 16). At the time of CVH repair, intraperitoneal placement of the biosynthetic mesh significantly increased the risk of recurrences (P ≤ 0.04). Surgical site infections (19/104) led to higher risk of recurrence (P < 0.01). Mean 24-month EQ-5D (index and visual analogue) and SF-12 physical component and mental scores improved from baseline (P < 0.05).Conclusions:In this prospective longitudinal study, biosynthetic absorbable mesh showed efficacy in terms of long-term recurrence and quality of life for CVH repair patients and offers an alternative to biologic and permanent synthetic meshes in these complex situations.

Early and Late Outcome After Suprasonic Excision of Infected Mesh Implants After Hernioplasty

“…To reduce the frequency of complications different authors suggest applying different surgical techniques of hernia repair and using different materials (19)(20)(21).…”

Biodegradable hyaluronan hydrogel coatings on acellular dermis grafts—A potential strategy to improve biologic graft durability in hernia repair application

“…Collagen cross‐linking is associated with poor cellular infiltration, revascularization, remodeling, and integration of biologic grafts with host tissues, which can result in adverse events such as severe foreign body reaction, acute mechanical failure, and disintegration of the graft . There is currently an unmet need for innovative and improved biologic graft materials that are both biocompatible and mechanically durable to make them attractive over the newer and cheaper synthetic and biosynthetic meshes that have also shown some success in contaminated settings …”

Tratamiento de hernia ventral compleja contaminada en dos etapas

“…Se utilizó prótesis biosintética por temor a perpetuar agentes bacterianos de infección en prótesis sintéticas las bioprótesis se asociarme a una mayor recurrencia. La prótesis biosintética se asocia a una baja tasa de recurrencia y de infección en las hernias incisionales limpias-contaminadas y contaminadas 10,14 . La elección de la técnica de separación de componentes anterior se justifica por la destrucción de la hoja posterior del músculo recto abdominal, situación más frecuente en pacientes con cirugías previas.…”