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. 2022 Dec;74(6):1995-2001.
doi: 10.1007/s13304-022-01378-3. Epub 2022 Oct 12.

Semiresorbable biologic hybrid meshes for ventral abdominal hernia repair in potentially contaminated settings: lower risk of recurrence

Markus Goetz  1 , Maria Jurczyk  2 , Henrik Junger  2 , Hans J Schlitt  2 , Stefan M Brunner  2 , Frank W Brennfleck  2
Affiliations

Semiresorbable biologic hybrid meshes for ventral abdominal hernia repair in potentially contaminated settings: lower risk of recurrence

Markus Goetz et al. Updates Surg. 2022 Dec.

Abstract

In case of potential contamination, implantation of synthetic meshes in hernia and abdominal wall surgery is problematic due to a higher risk of mesh infection. As an alternative, a variety of different biologic meshes have been used. However, relevant data comparing outcome after implantation of these meshes are lacking. Between January 2012 and October 2021, biologic meshes were used for reconstruction of the abdominal wall in 71 patients with preoperative or intraoperative abdominal contamination. In this retrospective study, semiresorbable biologic hybrid meshes (BHM) and completely resorbable meshes (CRM) were compared and analyzed using a Castor EDC database. In 28 patients, semiresorbable biologic hybrid meshes were used; in 43 patients, completely resorbable meshes were used. Both groups showed no difference in age, gender, BMI, operation duration, hernia size and Charlson comorbidity index. The risk degree of surgical-site occurrences was graded according to the Ventral Hernia Working Group (VHWG) classification, and the median value was 3 (range 2-4) in the BHM group and 3 (range 2-4) in the CRM group. Hernia recurrence within 24 months after hernia repair was significantly lower in the BHM group (3.6% vs. 28.9%; p = 0.03), while postoperative complication rate, with respect to seromas in need of therapy (61.4% vs. 55.5%, p = 0.43) and operative revision (28.6% vs. 16.3%, p = 0.22) was not different in either group. Biologic hybrid meshes can be used safely in case of possible contamination. BHM seems to reduce the risk of hernia recurrence compared to completely resorbable biologic meshes, but this has to be investigated further.

Keywords: Abdominal wall reconstruction; Biologic mesh; Incisional hernia; Wound contamination.

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Conflict of interest statement

Frank W. Brennfleck has received research grants from the companies 3M and KCI and is consultant for 3M and TELA Bio, Inc., and Markus Goetz, Maria Jurczyk, Henrik Junger, Hans J. Schlitt, and Stefan M. Brunner declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Shown is a Kaplan–Meier curve of recurrence-free survival within the first 24 months after hernia repair. Hernia recurrence is significantly lower (p = 0.03) in the BHM group (median follow-up in the BHM group is 16 months; marked with dotted line)
Fig. 2
Fig. 2
Both groups show a notable increase in the CRP score within the first 3 days after mesh implantation. Although slowly decreasing afterwards, CRP levels stay elevated over the next several days. No significant difference is seen between groups
Fig. 3
Fig. 3
Similar to the CRP levels, the white blood cell count also increases until day 3 after the operation, and decreases over the following days. No statistical difference is seen between groups
Fig. 4
Fig. 4
Shown is the PCT level course over the first 14 days. In the CRM group, the PCT level is higher than in the BHM group until postoperative day 10. Afterwards, the curves begin to align. No significant difference is reached
See this image and copyright information in PMC

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