Abstract
Introduction
Patients with higher postoperative infection risk undergoing ventral hernia repair (VHR) have limited options for mesh use. Biosynthetic mesh is intended to utilize the durability of synthetic mesh combined with the biocompatibility of biologic mesh. We sought to assess the outcomes of a novel biosynthetic scaffold mesh for VHR in higher risk patients over a 12-month postoperative period.
Methods
Two cohorts of 50 consecutive patients who underwent VHR with TELA Bio OviTex biosynthetic or synthetic mesh were retrospectively compared. Endpoints included surgical site occurrence (SSO), readmission rate, and hernia recurrence following VHR at 12 months postoperatively.
Results
OviTex mesh placement was associated with higher risk Ventral Hernia Working Group (VHWG) distribution and more contaminated CDC wound class distribution compared to synthetic mesh placement (VHWG grade 3: 68% vs. 6%, p < 0.001; CDC class > I: 70% vs. 6%, p < 0.001). Additionally, concomitant procedures were performed more often with OviTex mesh placement than synthetic mesh placement (70% vs 10%, p < 0.001). The OviTex mesh performed comparably to synthetic mesh in terms of incidences of SSO (36% vs 22%, p = 0.19), readmission rates (24% vs 14%, p = 0.31), and hernia recurrence (6% vs 12%, p = 0.74). On further evaluation, patients who developed SSO with OviTex mesh (n = 18) had a 17% hernia recurrence whereas those with synthetic mesh (n = 11) had an associated 55% hernia recurrence (p = 0.048).
Conclusions
The OviTex biosynthetic mesh was used in higher risk patients and performed similarly to synthetic mesh in regards to rate of SSO, readmissions, and hernia recurrence. Furthermore, patients who developed SSO with Ovitex mesh were significantly less likely to have hernia recurrence than those with synthetic mesh. Overall, the data suggest that biosynthetic mesh is a more desirable option for definitive hernia repair in higher risk patients.
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Abbreviations
- VHR:
-
Ventral hernia repair
- VHWG:
-
Ventral Hernia Working Group
- CDC:
-
Centers for Disease Control and Prevention
- BMI:
-
Body mass index
- SSO:
-
Surgical site occurrence
- LOS:
-
Length of stay
- CPT:
-
Current procedural terminology
References
Bryan N, Battersby C, Smart N, Hunt J (2015) A review of biocompatibility in hernia repair; considerations in vitro and in vivo for selecting the most appropriate repair material. Hernia 19:169–178
Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558
Kanters AE, Krpata DM, Blatnik JA, Novitsky YM, Rosen MJ (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 215:787–793
FitzGerald JF, Kumar AS (2014) Biologic versus synthetic mesh reinforcement: what are the pros and cons? Clin Colon Rectal Surg 27:140–148
Bondre IL, Holihan JL, Askenasy EP, Greenberg JA, Keith JN, Martindale RG, Roth JS, Liang MK (2016) Suture, synthetic, or biologic in contaminated ventral hernia repair. J Surg Res 200:488–494
Reid CM, Jacobsen GR (2018) A current review of hybrid meshes in abdominal wall reconstruction. PlastReconstrSurg 142:92s–96s
Rosen MJ, Bauer JJ, Harmaty M, Carbonell AM, Cobb WS, Matthews B, Goldblatt MI, Selzer DJ, Poulose BK, Hansson BM, Rosman C, Chao JJ, Jacobsen GR (2017) Multicenter, prospective, longitudinal study of the recurrence, surgical site infection, and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh: the COBRA study. Ann Surg 265:205–211
Sahoo S, Haskins IN, Huang LC, Krpata DM, Derwin KA, Poulose BK, Rosen MJ (2017) Early wound morbidity after open ventral hernia repair with biosynthetic or polypropylene mesh. J Am Coll Surg 225:472–480.e471
Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183
Baucom RB, Ousley J, Feurer ID, Beveridge GB, Pierce RA, Holzman MD, Sharp KW, Poulose BK (2016) Patient reported outcomes after incisional hernia repair-establishing the ventral hernia recurrence inventory. Am J Surg 212:81–88
Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583 discussion 583-575
Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398
Lake SP, Stoikes NFN, Badhwar A, Deeken CR (2019) Contamination of hybrid hernia meshes compared to bioresorbable Phasix™ Mesh in a rabbit subcutaneous implant inoculation model. Ann Med Surg 46:12–16
Ferzoco SJ (2018) Early experience outcome of a reinforced Bioscaffold in inguinal hernia repair: a case series. Int J Surg Open 12:9–11
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Mitchell J. Parker, Rachel C. Kim, Martin Barrio, Juan Socas, Lawrence R. Reed, Attila Nakeeb, Michael G. House and Eugene P. Ceppa declares that they have no conflicts of interest or financial ties to disclose.
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Parker, M.J., Kim, R.C., Barrio, M. et al. A novel biosynthetic scaffold mesh reinforcement affords the lowest hernia recurrence in the highest-risk patients. Surg Endosc 35, 5173–5178 (2021). https://doi.org/10.1007/s00464-020-08009-1
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DOI: https://doi.org/10.1007/s00464-020-08009-1