Thomas S Auer, Prof, MD, James E Waha, MD, Daniela Kniepeiss, PhDMD. University Clinic of Surgery Graz
Introduction: Infected or contaminated hernia places still present very demanding and not solved surgical challenge. Biological meshes were thought to solve the problem of infected hernia situations and complex hernia in high risk patients. However, recent results were disappointing for the benefit of the use of the cost intensive material. In vitro and animal studies have demonstrated an enhanced bacterial growth and late hydrolysis, after 15 to 18 months, for P4HB meshes, and the remaining scar tissue of high strength.
Methods and Procedures: Between September 2015 and September 2017, 37 Patients were operated for complex, infected and small hernia, using the bio-absorbable P4 HB meshes. The meshes were placed mainly in onlay position, in some cases sublay or as a supplement enforcement onlay when a permanent mesh was placed sublay (sandwich). For groin hernia, TAPP procedure was used.
Results: All cases showed a primary ingrowth of the mesh, none had to be explanted. Observation period is 4- 24months ( mean 12). The main complication was observed with 2 cases of seroma, one of them infected. 3 Patients were re-operated due to skin necrosis. In these cases, the meshes left in site and were seen and documented with excellent granulation activity. No hernia recurrence was observed in the first 12 months, 1 recurrence in the first 24 months.
Conclusions: The use of P4 HB meshes showed to be an excellent plan B for very complicated and infected hernia cases that need repair. Onlay position of these meshes is not an additive risk factor also in complicate skin situation. P4HB mesh can be considered as an alternative to permanent mesh or suture alone for small incisional and groin hernia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86302
Program Number: P043
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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