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Long-term results with biosynthetic absorbable P4HB mesh in ventral abdominal wall repair: a multicentre analysis

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Abstract

Background

The aim of this multicentre study was to analyse the outcomes of biosynthetic absorbable poly-4-hydroxybutyrate (P4HB) prosthesis implantation in patients undergoing ventral hernia repair (VHR) in the context of different degrees of contamination.

Methods

From May 2016 to December 2021, a multicentre retrospective analysis of patients who underwent elective or urgent hernia repair with P4HB prosthesis was performed in seven hospitals in Spain and Portugal. Patients with a postoperative follow-up of less than 20 months and those within the theoretical period of prosthesis resorption were excluded from the study. Regarding the degree of contamination, patients were assessed according to the modified Ventral Hernia Working Group (VHWG) classification. Epidemiological data, hernia characteristics, surgical and postoperative variables (Clavien–Dindo classification) of these patients were analyzed. Risk factors related to long-term recurrence were studied by a multivariate analysis.

Results

In 236 cases of P4HB prosthesis implantation, repair in cases of Grade 3 was the most frequent (49.1%), followed by Grade 2 in 42.3% of cases and Grade 1 in 8.4%. The most frequent complications were Grade 1, with the majority occurring during the first year. The overall rate of surgical site occurrences (SSO) was 30%. The hernia recurrence rate was 14.4% (n = 34), with a mean postoperative follow-up time of 41 months (22–61). The multivariate analysis showed that the onlay location of the mesh (OR 1.07; CI 1.42–2.70, p = 0.004) was a significant independent risk factor for recurrence.

Conclusions

The use of a P4HB bioresorbable mesh for the VHR with different degrees of contamination leads to favourable results overall, with an acceptable rate of hernia recurrence. The onlay location of the P4HB prosthesis is the main factor in recurrence in both elective and emergency settings.

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Acknowledgements

We would like to thank to Santiago Bonafé, Providencia Garcia-Pastor, Victoria Pareja and Omar Carreño of our surgical group for their helpful discussions.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari I Poltecnic La Fe, Fernando Abril Martorell, 106, 46026, Valencia, Spain

    J. Bueno-Lledó & S. Pous-Serrano

  2. Department of Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain

    B. Porrero-Guerrero

  3. Complex Abdominal Wall Unit, ULS Hospital Pedro Hispano, Matosihnos, Portugal

    F. Ferreira

  4. Hospital Clínico Universitario San Carlos, Madrid, Spain

    M. J. Peña-Soria

  5. Hospital Universitario Gregorio Marañón, Madrid, Spain

    M. Sanz-Sánchez

  6. Unit of Abdominal Wall Surgery, Hospital Universitario Virgen de Las Nieves, Granada, Spain

    A. Mansilla-Roselló & R. Rejón-López

  7. Unit of Abdominal Wall Surgery, Hospital Garcia de Orta, Almada, Portugal

    R. Souto

Authors
  1. J. Bueno-Lledó
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  2. B. Porrero-Guerrero
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  3. F. Ferreira
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  4. M. J. Peña-Soria
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  5. M. Sanz-Sánchez
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  6. A. Mansilla-Roselló
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  7. R. Souto
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  8. R. Rejón-López
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  9. S. Pous-Serrano
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Corresponding author

Correspondence to J. Bueno-Lledó.

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Conflict of interest

Dr. Bueno-Lledó has been speaker for BD surgical and had grants with BD surgical (workshops). These disclosures do not impact the topics reported herein. All other authors declare no disclosures relevant to this article or research, and have no conflicts of interest or financial ties to disclose. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Bueno-Lledó, J., Porrero-Guerrero, B., Ferreira, F. et al. Long-term results with biosynthetic absorbable P4HB mesh in ventral abdominal wall repair: a multicentre analysis. Hernia (2024). https://doi.org/10.1007/s10029-024-02981-6

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