Elsevier

Surgery

Volume 160, Issue 4, October 2016, Pages 828-838
Surgery

Central Surgical Association
Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs

Presented at the 2016 Central Surgical Association Annual Meeting, Montreal, Quebec, Canada, March 10–12, 2016.
https://doi.org/10.1016/j.surg.2016.04.041Get rights and content

Background

Contaminated operative fields pose significant challenges for surgeons performing ventral hernia repair. Although biologic meshes have been utilized increasingly in these fields, recent evidence suggests that synthetic meshes represent a viable option. We analyzed the outcomes of biologic and synthetic mesh utilized in patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields.

Methods

We conducted a multicenter, retrospective review of patients undergoing open ventral hernia repair in clean-contaminated/contaminated fields using biologic or synthetic mesh. Patient and hernia details were characterized. Primary outcomes included 90-day surgical site event, surgical site infection, and hernia recurrence.

Results

A total of 126 patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields (69 biologic and 57 synthetic meshes) were analyzed. Groups were similar in both patient and hernia characteristics. There were 13 (22.8%) surgical site events in the synthetic cohort compared to 29 (42.0%) in the biologic cohort, P = .024. Similarly, surgical site infections were less frequent in the synthetic group, with 7 (12.3%) vs 22 (31.9%), P = .01. With a mean follow-up of 20 months, there were more recurrences in the biologic group: 15 (26.3%) vs 4 (8.9%) in the synthetic group, P = .039.

Conclusion

The choice of mesh for clean-contaminated/contaminated ventral hernia repair remains debatable. We demonstrated that using synthetic sublay mesh resulted in a significantly lower wound morbidity and more durable outcomes versus a similar cohort of biologic repairs. This is likely secondary to improved bacterial clearance and faster integration of macroporous synthetics. Overall, our findings not only support suitability of synthetic mesh in contaminated settings but also challenge the purported advantage of biologics in clean-contaminated/contaminated ventral hernia repairs.

Section snippets

Methods

With Institutional Review Board approval, we performed a multicenter analysis on patients undergoing major open VHR in clean-contaminated and contaminated fields from prospectively maintained hernia databases. All surgeons involved in the study were part of tertiary hernia care referral centers. We included all patients who underwent elective VHRs with biologic or synthetic mesh placed in Centers for Disease Control and Prevention (CDC) wound class II or III.10 Patients with grossly dirty

Demographics and hernia characteristics

Between June 2009 and March 2015, 126 consecutive patients who underwent open VHR using either biologic or synthetic mesh in clean-contaminated or contaminated operative fields were analyzed. Patient demographics, comorbidities, and hernia characteristics are summarized in Table II. More than half the patients were women in both the biologic and synthetic groups, with nonsignificant preponderance of women in the biologic cohort compared to a near even distribution in the synthetic group. There

Discussion

The optimal operative solution for hernia repair in contaminated fields remains elusive. The range of reconstructive options varies widely from staged primary repair to definitive repair with component separation and mesh reinforcement of the visceral sac.6, 15 Despite the risk of infections, mesh reinforcement continues to play a considerable role in hernia repair in contaminated operative fields. Importantly, there remains active debate on whether biologic or synthetic meshes offer the safest

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    • Cited by (0)

    No external funds or financial support were used for this study. AM, JSW, and YW have no conflicts of interest to disclose. EMP is a paid consultant for W.L. Gore & Associates, Inc, Cook Group Inc, and has received research support from Cook Group Inc and Miromatrix Medical Inc. IB is a paid consultant for LifeCell Corp and Covidien Ltd. YWN is a paid consultant for C. R. Bard, Inc and Cooper Surgical, Inc and has received research support from C. R. Bard, Inc.

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