A novel biosynthetic scaffold mesh reinforcement affords the lowest hernia recurrence in the highest-risk patients
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...
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Published in | Surgical endoscopy Vol. 35; no. 9; pp. 5173 - 5178 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
01.09.2021
Springer Nature B.V |
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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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AbstractList | INTRODUCTIONPatients 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. METHODSTwo 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. RESULTSOviTex 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). CONCLUSIONSThe 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. 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. |
Author | Parker, Mitchell J. Nakeeb, Attila Reed, Lawrence R. Kim, Rachel C. Barrio, Martin Socas, Juan Ceppa, Eugene P. House, Michael G. |
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Cites_doi | 10.1097/01.sla.0000141193.08524.e7 10.1056/NEJM200008103430603 10.1007/s10029-014-1307-8 10.1016/j.amsu.2019.08.004 10.1016/j.jss.2015.09.007 10.1016/j.surg.2010.01.008 10.1055/s-0034-1394155 10.1007/s10029-011-0879-9 10.1016/j.ijso.2018.06.001 10.1016/j.amjsurg.2015.06.007 10.1016/j.jamcollsurg.2017.07.1067 10.1097/SLA.0000000000001601 10.1016/j.jamcollsurg.2012.08.012 |
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Keywords | Contaminated ventral hernia repair Ventral hernia repair TELA bio OviTex Biosynthetic hybrid mesh Synthetic mesh |
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Snippet | Introduction
Patients with higher postoperative infection risk undergoing ventral hernia repair (VHR) have limited options for mesh use. Biosynthetic mesh is... IntroductionPatients with higher postoperative infection risk undergoing ventral hernia repair (VHR) have limited options for mesh use. Biosynthetic mesh is... INTRODUCTIONPatients with higher postoperative infection risk undergoing ventral hernia repair (VHR) have limited options for mesh use. Biosynthetic mesh is... |
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SubjectTerms | Abdominal Surgery Body mass index Disease control Endoscopy Gastroenterology Gynecology Hepatology Hernias Infections Medicine Medicine & Public Health Patients Proctology Surgeons Surgery Surgical outcomes Synthetic products Working groups |
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Title | A novel biosynthetic scaffold mesh reinforcement affords the lowest hernia recurrence in the highest-risk patients |
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