Margaret A Plymale, DNP, RN, Daniel L Davenport, PhD, Adam Dugan, MS, Amanda Zachem, BSN, RN, John S Roth, MD. University of Kentucky
Introduction: Mesh repair of ventral and incisional hernia is known to be associated with superior outcomes compared with suture repair; however, wound complications and mesh infection have been associated with synthetic mesh, and biologic mesh is thought to be associated with higher risk of hernia recurrence. Evolution of mesh material has made available a biologically-derived fully resorbable poly-4-hydroxybutyrate (P4HB) mesh for use in ventral and incisional hernia repair (VIHR). This study evaluates outcomes of patients undergoing VIHR with P4HB and compares outcomes to patients who have undergone repair with synthetic or biologic mesh.
Methods and Procedures: An IRB-approved single institution prospective study was conducted to assess clinical and quality of life (QOL) outcomes for patients undergoing VIHR with P4HB. Clinical outcomes, employment status, QOL (using Short Form 12), and pain assessments were followed for 24 months postoperatively. Surgical databases from a six-year period of time were reviewed to identify matched patients that had undergone hernia repair with biologic mesh, and similarly a matched cohort of patients that underwent VIHR with synthetic mesh. Perioperative characteristics and clinical outcomes were compared by mesh type.
Results: 126 patients underwent VIHR: 31 with bioresorbable, 44 with biologic, and 51 with synthetic mesh. Patient mesh type groups were similar in age (median 55 years, p = .66), BMI (median 34 kg/m2, p = .10), gender (62% female, p = .71), wound class and comorbidities. Surgical site occurrences were more prevalent among patients with biologic mesh (46%) than synthetic (31%) or bioresorbable (19%), p = 0.006. Hernia recurrence rates were 0% in bioresorbable mesh (median follow up = 414 days), 8% for synthetic mesh (median follow up of 121 days), and18% for biologic mesh (median follow up of 439 days), (p = .02). Patients with bioresorbable mesh had improved QOL scores at 24 months compared to baseline for SF 12 physical component summary and role emotional (p < .05).
Conclusions: Ventral hernia repair with P4HB bioresorbable mesh results in fewer surgical site occurrences than hernia repairs with synthetic or biologic mesh. Hernia recurrence rates differ between biologic, synthetic and bioresorbable mesh with highest recurrence rates occurring in biologic mesh repairs. Quality of life improvements were noted at 24 months for the patients with bioresorbable mesh.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80060
Program Number: S056
Presentation Session: Ventral Hernias
Presentation Type: Podium
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