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

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 27; no. 2; pp. 387 - 394
• Main Authors: Layer, T., Benammi, S., Dubuisson, V., Manfredelli, S., Passot, G., Charleux-Muller, D., Renard, Y., Ortega-Deballon, P., Romain, B.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.04.2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Abdominal wall; Hernia; Hernia, Ventral - surgery; Hernias; Herniorrhaphy - adverse effects; Humans; Incisional Hernia - surgery; Medicine; Medicine & Public Health; Multivariate analysis; Original Article; Procollagen-Proline Dioxygenase; Protein Disulfide-Isomerases; Recurrence; Retrospective Studies; Risk factors; Risk groups; Surgical Mesh - adverse effects; Surgical site infections; Treatment Outcome; Incisional hernia repair; Recurrence; Biosynthetic mesh; Contaminated surgery
• ISSN: 1248-9204; 1265-4906; 1248-9204
• DOI: 10.1007/s10029-022-02616-8

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.