John S Roth, MD1, Gary Anthone, MD2, Donald J Selzer, MD3, Ben Poulose, MD4, James Bittner, MD5, William Hope, MD6, Robert Martindale, MD7, Raymond Dunn, MD8, Matthew Goldblatt, MD9, Gregory Mancini, MD10, David Earle, MD11, Romanelli John, MD11, Jacob Greenberg, MD12, Eduardo Parra Davila, MD13, John Linn, MD14, Guy Voeller, MD15, Bryan Sandler, MD16. 1University of Kentucky, 2Methodist Physicians Clinic, 3Indiana University, 4Vanderbilt University, 5VCU, 6New Hanover Medical Center, 7Oregon Health and Sciences University, 8University of Massachusetts Worcester, 9Medical College of Wisconsin, 10University of Tennessee – Knoxville, 11Baystate Medical Center, 12University of Wisconsin, 13Florida Hospital, 14NorthShore University Health, 15University of Tennessee – Memphis, 16University of California San Diego
Introduction: Long-term resorbable mesh represents a promising technology for complex ventral and incisional hernia repair (VIHR). Preclinical studies indicate that Poly-4- hydroxybutyrate (P4HB) bioresorbable mesh supports strength restoration of the abdominal wall. This study evaluates outcomes of CDC Class I/High-Risk patients undergoing VIHR with P4HB mesh.
Methods: This is a prospective multi-institutional study of patients undergoing retro-rectus or onlay VIHR. Inclusion criteria are: CDC Class I, defect 10-350cm2, ≤3 prior repairs, and ≥1 high-risk criteria (i.e. obesity, active smoker, COPD, diabetes, immunosuppression, coronary disease, steroid use, hypo-albuminemia, advanced age and renal insufficiency). Physical exam and/or quality of life surveys are performed at regular intervals through 36 months.
Results: 121 patients (46M, 75F) with a mean age of 54.7+/-12.0 and BMI of 32.2 +/-4.5 underwent VIHR. Comorbid conditions include: obesity (78.5%), hypertension (59.5%), COPD (28.1%), cardiovascular disease (34.7%), diabetes (33.1%), active smoker (24.0%), malignancy (24.8%), immunosuppression (8.3%), and steroid use (6.6%). Hernia types include: primary ventral hernia (14%), primary incisional hernia (44.6%), recurrent ventral hernia (12.4%), and recurrent incisional hernia (28.9%). Mean defect and mesh size are: 115.7+/-80.6 cm2 and 580.9+/-216.1cm2 respectively. Repair types include: retro-rectus (43, 35.5%), retro-rectus with component separation (45, 37.2%), onlay (24, 19.8%) and onlay with component separation (8, 6.6%). 95 patients have completed 18 months follow-up to date. Postoperative wound infection, seroma requiring intervention and hernia recurrence occurred in 11 (9.1%), 8 (6.6%) and 11 (9.1%) [6 Onlay (19% of the Onlay group) and 5 RR (6% of the RR group)] patients respectively.
Conclusion: Complex VIHR with P4HB mesh demonstrated positive outcomes and low incidence of hernia recurrence at 18 months. Longer-term follow-up is ongoing.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78955
Program Number: S054
Presentation Session: Ventral Hernias
Presentation Type: Podium