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Absorbable Polyglactin vs. Non-Cross-linked Porcine Biological Mesh for the Surgical Treatment of Infected Incisional Hernia

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The use of absorbable meshes during contaminated or infected incisional hernia (IH) repair is associated with high morbidity and recurrence rates. Biological meshes might be more appropriate but have been described in highly heterogeneous series. This study aimed at comparing the efficacy of absorbable vs. biological meshes for the treatment of contaminated or infected IH in a homogeneous series with a standardized technique.

Methods

Data of all patients operated on between 2008 and 2015 for contaminated or infected IH, using an absorbable (A) Vicryl® or a biological (B) Strattice® mesh, were reviewed. Patient characteristics, infectious complication rates, and recurrence-free outcome (RFO) were compared between the two groups. A propensity score methodology was applied to a Cox regression model to deal with unbalanced characteristics between groups.

Results

Patient demographics in A (n = 57) and in B (n = 24) were similar except that B patients had larger parietal defects (p < 0.001) and higher Center for Disease Control (CDC) wound class (p = 0.034). Patients in A had statistically significantly more postoperative early (61.4% vs. 33.3%, p = 0.03) and late (31.2% vs. 8.3%, p = 0.046) infectious complications. Six-, 12-, and 36-month RFO rates were 77%, 47%, and 24%, and 96%, 87%, and 82% in A and B, respectively, p < 0.001. Raw multivariable Cox regression analysis found that B (HR = 0.1, 95% CI [0.03–0.34], p < 0.001) was independently associated with prolonged RFO (HR = 0.091, 95% CI [0.045–0.180], p < 0.001).

Conclusion

Biological meshes seem to be superior to absorbable meshes in patients with contaminated or infected incisional hernia. These results need to be confirmed by prospective randomized trials.

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Abbreviations

CDC:

Center for Disease Control

IH:

Incisional hernia

A:

Absorbable (Vicryl ®) mesh group

B:

Biological (Strattice®) mesh group

VHWG:

Ventral Hernia Working Group

SSI:

Surgical site infection

RFO:

Recurrence-free occurrence

IPTM:

Inverse of probability treatment method

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Authors and Affiliations

  1. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France

    Yohann Renard, Jean-Pierre Palot & Reza Kianmanesh

  2. Department of Gastroenterology and Pancreatology, Paris 7 University, Beaujon Hospital (APHP), Clichy, France

    Louis de Mestier

  3. Department of Methodology and Quality of Life (INSERM UMR 1098), Besançon University Hospital, Besançon, France

    Julie Henriques

  4. Epidemiology and Public Health Department, Kremlin-Bicêtre University Hospital, Le Kremlin-Bicêtre, France

    Paul de Boissieu

  5. Department of General Surgery, Clinique Saint Jean de Dieu, Paris, France

    Philippe de Mestier

  6. Unit of Surgical Research, Department of Surgery, University Hospital of Graz, Graz, Austria

    Abe Fingerhut

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  1. Yohann Renard
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Contributions

All authors have made substantial contributions to the manuscript; have participated in the acquisition, analysis, and interpretation of data; and have participated in the drafting and revision of the work.

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Correspondence to Yohann Renard.

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Yohann Renard has received honoraria from Company BARD, but not in any way related to this study. The remaining authors have no conflict of interest to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Renard, Y., de Mestier, L., Henriques, J. et al. Absorbable Polyglactin vs. Non-Cross-linked Porcine Biological Mesh for the Surgical Treatment of Infected Incisional Hernia. J Gastrointest Surg 24, 435–443 (2020). https://doi.org/10.1007/s11605-018-04095-8

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