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Comparative long-term effectiveness between ventral hernia repairs with biosynthetic and synthetic mesh

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Abstract

Background

Debate exists regarding the most appropriate type of mesh to use in ventral hernia repair (VHR). Meshes are broadly categorized as synthetic or biologic, each mesh with individual advantages and disadvantages. More recently developed biosynthetic mesh has characteristics of both mesh types. The current study aims to examine long-term follow-up data and directly compare outcomes—specifically hernia recurrence—of VHR with biosynthetic versus synthetic mesh.

Methods

With IRB approval, consecutive cases of VHR (CPT codes 49,560, 49,561, 49,565, and 49,566 with 49,568) performed between 2013 and 2018 at a single institution were reviewed. Local NSQIP data was utilized for patient demographics, perioperative characteristics, CDC Wound Class, comorbidities, and mesh type. A review of electronic medical records provided additional variables including hernia defect size, postoperative wound events to six months, duration of follow-up, and incidence of hernia recurrence. Longevity of repair was measured using Kaplan–Meier method and adjusted Cox proportional hazards regression.

Results

Biosynthetic mesh was used in 101 patients (23%) and synthetic mesh in 338 (77%). On average, patients repaired using biosynthetic mesh were older than those with synthetic mesh (57 vs. 52 years; p = .008). Also, ASA Class ≥ III was more common in biosynthetic mesh cases (70.3% vs. 55.1%; p = .016). Patients repaired with biosynthetic mesh were more likely than patients with synthetic mesh to have had a prior abdominal infection (30.7% vs. 19.8%; p = .029). Using a Kaplan–Meier analysis, there was not a significant difference in hernia recurrence between the two mesh types, with both types having Kaplan Meir 5-year recurrence-free survival rates of about 72%.

Conclusion

Using Kaplan–Meier analysis, synthetic mesh and biosynthetic mesh result in comparable hernia recurrence rates and surgical site infection rates in abdominal wall reconstruction patients with follow-up to as long as five years.

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Authors and Affiliations

  1. College of Medicine, University of Kentucky, Lexington, KY, USA

    Benjamin G. Morrison & Kiah Gledhill

  2. Division of General, Endocrine & Metabolic Surgery, Department of Surgery, University of Kentucky, C 240, Chandler Medical Center, 800 Rose Street, Lexington, KY, 40536, USA

    Margaret A. Plymale & John S. Roth

  3. Division of Health Outcomes and Optimal Patient Services, Department of Surgery, University of Kentucky, Lexington, KY, USA

    Daniel L. Davenport

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Correspondence to John S. Roth.

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Disclosures

Dr. John S. Roth has the following to disclose: Grants from Beckton Dickinson & Company, Gore, and Advanced Medical Solutions (paid to institution); consulting for Beckton Dickinson & Company, Medtronic, and Abbvie. Mr. Benjamin G. Morrison, Mr. Kiah Gledhill, and Drs. Margaret A. Plymale and Daniel L. Davenport have no conflicts of interest or financial ties to disclose.

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Morrison, B.G., Gledhill, K., Plymale, M.A. et al. Comparative long-term effectiveness between ventral hernia repairs with biosynthetic and synthetic mesh. Surg Endosc 37, 6044–6050 (2023). https://doi.org/10.1007/s00464-023-10082-1

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  • DOI: https://doi.org/10.1007/s00464-023-10082-1

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