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A comparison of patient-reported outcomes in patients undergoing abdominal wall repair with either synthetic or biosynthetic mesh: a pilot study

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Abstract

Purpose

Repair of midline ventral incisional hernias (VIHR) requires mesh reinforcement. Mesh types can be categorised into synthetic, biosynthetic, or biological. There is a lack of evidence to support one type of mesh over another. The aim of this pilot study was to compare mesh sensation in patients having undergone elective open repair with synthetic or biosynthetic mesh.

Methods

Four years of prospectively collected data were retrospectively reviewed on 40 patients who had undergone VIHR, using either biosynthetic or synthetic mesh placed in the retromuscular plane. The decision on type of mesh used was governed by patient characteristics. Patients were invited to complete the Carolinas Comfort Scale (CCS) questionnaire, the higher the score indicating a poorer quality of life. The maximum length of follow-up was 36 months.

Results

Twenty patients received permanent synthetic and 20 biosynthetic mesh. There was no clinical evidence of hernia recurrence in either group in the short to medium term. Overall, 97% (39/40) patients reported an average of either no or mild symptoms (mean CCS score 17.9 of 115). Patients with a biosynthetic repair had a significant lower CCS at ≥ 18 months (p < 0.05).

Conclusion

After VIHR, patients have low CCS scores, indicating good quality of life outcomes, in the short to medium term irrespective of the mesh used. However, biosynthetic mesh had lower CCS scores in the medium term. This may help surgeons and patients make better informed decisions about which mesh to use in their individual circumstances.

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Data availability

The data that support these findings are available upon request from the corresponding author (Kulkarni G.V).

References

  1. 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(4):578–583. https://doi.org/10.1097/01.sla.0000141193.08524.e7

    Article  PubMed  PubMed Central  Google Scholar 

  2. Löfgren J, Matovu A, Wladis A, Ibingira C, Nordin P, Galiwango E, Forsberg BC (2017) Cost-effectiveness of groin hernia repair from a randomized clinical trial comparing commercial versus low-cost mesh in a low-income country. Br J Surg 104(6):695–703. https://doi.org/10.1002/bjs.10483

    Article  PubMed  Google Scholar 

  3. Parker MJ, Kim RC, Barrio M, Socas J, Reed LR, Nakeeb A, House MG, Ceppa EP (2021) A novel biosynthetic scaffold mesh reinforcement affords the lowest hernia recurrence in the highest-risk patients. Surg Endosc 35(9):5173–5178. https://doi.org/10.1007/s00464-020-08009-1

    Article  PubMed  Google Scholar 

  4. Bachman S, Ramshaw B (2008) Prosthetic material in ventral hernia repair: how do I choose? Surg Clin N Am 88(1):101–112. https://doi.org/10.1016/j.suc.2007.11.001

    Article  PubMed  Google Scholar 

  5. Kamarajah SK, Smart NJ, Daniels IR, Pinkney TD, Harries RL (2021) Bioabsorbable mesh use in midline abdominal wall prophylaxis and repair achieving fascial closure: a cross-sectional review of stage of innovation. Hernia 25(1):3–12. https://doi.org/10.1007/s10029-020-02217-3

    Article  CAS  PubMed  Google Scholar 

  6. Köckerling F, Alam NN, Antoniou SA, Daniels IR, Famiglietti F, Fortelny RH, Heiss MM, Kallinowski F, Kyle-Leinhase I, Mayer F, Miserez M, Montgomery A, Morales-Conde S, Muysoms F, Narang SK, Petter-Puchner A, Reinpold W, Scheuerlein H, Smietanski M, Stechemesser B, Strey C, Woeste G, Smart NJ (2018) What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia 22(2):249–269. https://doi.org/10.1007/s10029-018-1735-y

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lee TJ, Ulisney KL, Choudhuri AK, Swiger JL, Gibeily GJ (2019) Understanding the patient perspective after ventral hernia repair. Hernia 23(5):995–1001. https://doi.org/10.1007/s10029-019-02015-6

    Article  PubMed  Google Scholar 

  8. Smith OA, Mierzwinski MF, Chitsabesan P, Chintapatla S (2022) Health-related quality of life in abdominal wall hernia: let’s ask patients what matters to them? Hernia 26(3):795–808. https://doi.org/10.1007/s10029-022-02599-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Antic A, Kmezic S, Nikolic V, Radenkovic D, Markovic V, Pejovic I, Aleksic L, Loncar Z, Antic S, Kovac J, Markovic-Denic L (2022) Quality of life following two different techniques of an open ventral hernia repair for large hernias: a prospective randomized study. BMC Surg 22(1):99. https://doi.org/10.1186/s12893-022-01551-w

    Article  PubMed  PubMed Central  Google Scholar 

  10. Patel V, Hsu JY, Broach RB, Morris MP, Christopher AN, Nathan SN, Cunning JR, Poulose BK, Fischer JP (2022) Calibration of hernia-specific patient-reported outcome measures. J Surg Res 276:182–188. https://doi.org/10.1016/j.jss.2022.02.021

    Article  PubMed  Google Scholar 

  11. Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B, Novitsky YW, Rosen MJ (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215(5):635–642. https://doi.org/10.1016/j.jamcollsurg.2012.06.412

    Article  PubMed  Google Scholar 

  12. Muysoms F, Campanelli G, Champault GG, DeBeaux AC, Dietz UA, Jeekel J, Klinge U, Köckerling F, Mandala V, Montgomery A, Morales Conde S, Puppe F, Simmermacher RK, Śmietański M, Miserez M (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16(3):239–250. https://doi.org/10.1007/s10029-012-0912-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206(4):638–644. https://doi.org/10.1016/j.jamcollsurg.2007.11.025

    Article  PubMed  Google Scholar 

  14. Heniford BT, Lincourt AE, Walters AL, Colavita PD, Belyansky I, Kercher KW, Sing RF, Augenstein VA (2018) Carolinas comfort scale as a measure of hernia repair quality of life: a reappraisal utilizing 3788 international patients. Ann Surg 267(1):171–176. https://doi.org/10.1097/SLA.0000000000002027

    Article  PubMed  Google Scholar 

  15. Van Rooijen MMJ, Tollens T, Jørgensen LN, de Vries Reilingh TS, Piessen G, Köckerling F, Miserez M, Windsor ACJ, Berrevoet F, Fortelny RH, Dousset B, Woeste G, van Westreenen HL, Gossetti F, Lange JF, Tetteroo GWM, Koch A, Jeekel J (2022) Slowly resorbable biosynthetic mesh: 2-year results in VHWG grade 3 hernia repair. Hernia 26(1):131–138. https://doi.org/10.1007/s10029-021-02453-1

    Article  PubMed  Google Scholar 

  16. Williams KB, Bradley JF, Wormer BA, Zemlyak AY, Walters AL, Colavita PD et al (2013) Postoperative quality of life after open transinguinal preperitoneal inguinal hernia repair using memory ring or three-dimensional devices. Am Surg 79(8):786–793. https://doi.org/10.1177/000313481307900819

    Article  PubMed  Google Scholar 

  17. Berger D, Bientzle M (2009) Polyvinylidene fluoride: a suitable mesh material for laparoscopic incisional and parastomal hernia repair! A prospective, observational study with 344 patients. Hernia 13(2):167–172. https://doi.org/10.1007/s10029-008-0435-4

    Article  CAS  PubMed  Google Scholar 

  18. Smith A, Slater K (2022) Outcomes of biosynthetic absorbable mesh use in high risk CDC class I ventral hernia repair: a single surgeon series. Hernia 26(1):97–108. https://doi.org/10.1007/s10029-021-02424-6

    Article  CAS  PubMed  Google Scholar 

  19. Finch D, Mehmood S, Varghese J (2021) Abdominal wall reconstruction using biosynthetic absorbable mesh in high-risk complex ventral hernia. Swiss Med Wkly 151:w20449. https://doi.org/10.4414/smw.2021.20449

    Article  PubMed  Google Scholar 

  20. Miserez M, Jairam AP, Boersema GSA, Bayon Y, Jeekel J, Lange JF (2019) Resorbable synthetic meshes for abdominal wall defects in preclinical setting: a literature review. J Surg Res 237:67–75. https://doi.org/10.1016/j.jss.2018.11.054

    Article  CAS  PubMed  Google Scholar 

  21. Messa CA 4th, Kozak G, Broach RB, Fischer JP (2019) When the mesh goes away: an analysis of poly-4-hydroxybutyrate mesh for complex hernia repair. Plast Reconstr Surg Glob Open 7(11):e2576. https://doi.org/10.1097/GOX.0000000000002576

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chartier C, ElHawary H, Baradaran A, Vorstenbosch J, Xu L, Efanov JI (2021) Tendon: principles of healing and repair. Semin Plast Surg 35(3):211–215. https://doi.org/10.1055/s-0041-1731632

    Article  PubMed  PubMed Central  Google Scholar 

  23. Burger JW, Lange JF, Halm JA, Kleinrensink GJ, Jeekel H (2005) Incisional hernia: early complication of abdominal surgery. World J Surg 29(12):1608–1613. https://doi.org/10.1007/s00268-005-7929-3

    Article  PubMed  Google Scholar 

  24. Hammond TM, Huang A, Prosser K, Frye JN, Williams NS (2008) Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia 12(5):475–481. https://doi.org/10.1007/s10029-008-0383-z

    Article  CAS  PubMed  Google Scholar 

  25. Sandø A, Rosen MJ, Heniford BT, Bisgaard T (2020) Long-term patient-reported outcomes and quality of the evidence in ventral hernia mesh repair: a systematic review. Hernia 24(4):695–705. https://doi.org/10.1007/s10029-020-02154-1

    Article  PubMed  Google Scholar 

  26. Rogmark P, Petersson U, Bringman S, Ezra E, Österberg J, Montgomery A (2016) Quality of life and surgical outcome 1 year after open and laparoscopic incisional hernia repair: PROLOVE: a randomized controlled trial. Ann Surg 263(2):244–250. https://doi.org/10.1097/SLA.0000000000001305

    Article  PubMed  Google Scholar 

  27. Rogmark P, Petersson U, Bringman S, Eklund A, Ezra E, Sevonius D, Smedberg S, Osterberg J, Montgomery A (2013) Short-term outcomes for open and laparoscopic midline incisional hernia repair: a randomized multicenter controlled trial: the ProLOVE (prospective randomized trial on open versus laparoscopic operation of ventral eventrations) trial. Ann Surg 258(1):37–45. https://doi.org/10.1097/SLA.0b013e31828fe1b2

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge the efforts of Dr. Jaspal Rajoo in assisting with the data collection for this study.

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Authors and Affiliations

  1. Department of Surgery, Broomfield Hospital, Mid and South Essex NHS Trust, Essex, CM1 7ET, UK

    G. V. Kulkarni, R. Rudd & T. M. Hammond

  2. Department of General Internal Medicine, St. Thomas Hospital, London, UK

    Z. Elliott

  3. St Andrew’s Centre of Plastic Surgery, Reconstruction and Burns, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, UK

    D. Barnes

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  1. G. V. Kulkarni
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Correspondence to G. V. Kulkarni.

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There are no financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

Ethical approval, Human and animal rights, Informed consent

Trust approval was sought prior to study commencement. All patients voluntarily gave informed consent for participation and study was conducted in accordance to principles laid by Declaration of Helsinki (1964). No animals were involved in this study.

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Kulkarni, G.V., Elliott, Z., Rudd, R. et al. A comparison of patient-reported outcomes in patients undergoing abdominal wall repair with either synthetic or biosynthetic mesh: a pilot study. Hernia (2024). https://doi.org/10.1007/s10029-024-03022-y

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