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Non-coated versus coated mesh for retrorectus ventral hernia repair: a propensity score-matched analysis of the Americas Hernia Society Quality Collaborative (AHSQC)

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Abstract

Purpose

The outcomes of utilizing anti-adhesive barrier-coated mesh in the retrorectus position during open ventral hernia repair are unknown. We compared the wound-related outcomes between non-coated (NCM) and coated mesh (CM) placed in the retrorectus space.

Methods

Patients undergoing elective, open, clean ventral hernia repair with retrorectus mesh were retrospectively identified in the Americas Hernia Society Quality Collaborative. Propensity score matching was performed based on clinically relevant demographic and operative covariates. The primary outcome was wound morbidity, defined as surgical site infection (SSI), surgical site occurrence (SSO), and SSO requiring procedural intervention (SSOPI).

Results

3609 patients were included (3281 NCM, 328 CM). Following 2:1 propensity score matching, rates of myofascial release remained the only statistically different matching parameter; external oblique releases were performed more frequently in the CM group (8% vs. 15%; p = 0.03). Rates of SSI (3% vs. 4%; p = 0.16) were similar between groups. Increased rates of SSO (13% vs. 18%; p = 0.045) and SSOPI (4% vs. 8%; p = 0.038) were observed in the CM group. The CM group had a higher rate of postoperative seroma (3% vs. 7%; p = 0.027) compared to the NCM group.

Conclusion

Barrier-coated mesh in the retrorectus position was associated with increased wound morbidity requiring procedural intervention. Due to a lack of clinical benefit, the use of more costly barrier-coated mesh in the retrorectus position is not justified for routine, open ventral hernia repairs at this time.

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Funding

The authors report no external funding source for this study.

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    J. D. Thomas

  2. Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    J. D. Thomas, A. Fafaj, S. J. Zolin, C. M. Horne, S. Rosenblatt, C. C. Petro, D. M. Krpata, M. J. Rosen & A. S. Prabhu

  3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    L.-C. Huang & S. Phillips

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  1. J. D. Thomas
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  2. A. Fafaj
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  3. S. J. Zolin
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  4. C. M. Horne
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  5. L.-C. Huang
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  8. C. C. Petro
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  9. D. M. Krpata
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Corresponding author

Correspondence to J. D. Thomas.

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Conflict of interest

AF declares a resident research grant from the AHSQC that is not related to the submitted work. DMK has received an educational grant from W.L Gore that is not related to the submitted work. ASP has received a research grant from Intuitive Inc. and personal fees from Intuitive Inc. and Medtronic Inc. that are not related to the submitted work. MJR declares to receive salary support from the AHSQC, research grants from Intuitive Inc. and Pacira Pharmaceuticals Inc., and to be a board member and have stock options from Ariste Medical; none of these conflicts of interest are related to the submitted work. All other authors declare no conflicts of interest.

Ethical approval

This study was approved by the Institution Review Board (IRB) at Cleveland Clinic.

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This study does not contain any studies with participants or animals performed by any of the authors.

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Thomas, J.D., Fafaj, A., Zolin, S.J. et al. Non-coated versus coated mesh for retrorectus ventral hernia repair: a propensity score-matched analysis of the Americas Hernia Society Quality Collaborative (AHSQC). Hernia 25, 665–672 (2021). https://doi.org/10.1007/s10029-020-02229-z

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