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Incisional hernia repair with a slowly absorbable P4HB mesh: what happens after the mesh disappears? A retrospective longitudinal clinical study

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Abstract

Purpose

To analyze the incisional hernia recurrence rate at a long-term follow-up using a biosynthetic long-term absorbable mesh in patients with a higher risk of surgical infection in a contaminated surgical field.

Methods

This was a retrospective multicentric study. All patients undergoing incisional hernia repair between 2016 and 2018 at 6 participating university centers were included. Patients were classified according to the Ventral Hernia Working Group (VHWG). All consecutive patients who underwent abdominal wall repair using biosynthetic long-term absorbable mesh (Phasix®) in contaminated fields (grade 3 and 4 of the VHWG classification) were included. Patients were followed-up until September 2021. Preoperative, operative, and postoperative data were collected. All patients’ surgical site infections (SSIs) and surgical site occurrences (SSOs) were recorded. The primary outcome of interest was the clinical incisional hernia recurrence rate.

Results

One hundred and eight patients were included: 77 with VHWG grade 3 (71.3%) and 31 with VHWG grade 4 (28.7%). Median time follow-up was 41 months [24; 63]. Twenty-four patients had clinical recurrence during the follow-up (22.2%). The SSI and SSO rates were 24.1% and 36.1%, respectively. On multivariate analysis, risk factors for incisional hernia recurrence were previous recurrence, mesh location, and postoperative enterocutaneous fistula.

Conclusions

At the 3 year follow-up, the recurrence rate with a biosynthetic absorbable mesh (Phasix®) for incisional hernia repair in high-risk patients (VHWG grade 3 and 4) seemed to be suitable (22.2%). Most complications occurred in the first year, and SSI and SSO rates were low despite high-risk VHWG grading.

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Author information

Author notes

  1. T. Layer and S. Benammi contributed equally to the work.

Authors and Affiliations

  1. Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France

    T. Layer, S. Benammi, S. Manfredelli, D. Charleux-Muller & B. Romain

  2. Department of Vascular and General Surgery, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France

    V. Dubuisson

  3. Department of Digestive and Oncologic Surgery, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France

    S. Manfredelli

  4. Department of General, Digestive and Endocrine Surgery, Hospital Lyon Sud, Hospices Civils de Lyon, 165, Chemin du grand Revoyet, Pierre Bénite, 69495, Lyon, France

    G. Passot

  5. EMR 3738, University Hospital, Claude Bernard Lyon 1, Lyon, France

    G. Passot

  6. Department of General and Digestive Surgery, Robert Debre University Hospital, University of Reims Champagne Ardenne, Reims, France

    Y. Renard

  7. Department of General and Digestive Surgery, University Hospital of Dijon, Dijon, France

    P. Ortega-Deballon

  8. Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200, Strasbourg, France

    B. Romain

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  1. T. Layer
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All authors have approved the manuscript and meet the requirements for authorship.

Corresponding author

Correspondence to B. Romain.

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Conflict of interest

The authors declare no conflict of interest. P Ortega Deballon received grants from Covidien/Medtronic, LifeCell/Acelity and Bard/Beckton-Dickinson within the past 5 years. V Dubuisson received grants from Bard/Beckton-Dickinson and LifeCell/Acelity within the past 5 years. Y Renard received grants from BD(r), LifeCell/Acelity and Hartmann within the past 5 years.

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Layer, T., Benammi, S., Dubuisson, V. et al. Incisional hernia repair with a slowly absorbable P4HB mesh: what happens after the mesh disappears? A retrospective longitudinal clinical study. Hernia 27, 387–394 (2023). https://doi.org/10.1007/s10029-022-02616-8

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  • DOI: https://doi.org/10.1007/s10029-022-02616-8

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