A novel biosynthetic scaffold mesh reinforcement affords the lowest hernia recurrence in the highest-risk patients

Mitchell J Parker; Rachel C Kim; Martin Barrio; Juan Socas; Lawrence R Reed; Attila Nakeeb; Michael G House; Eugene P Ceppa

doi:10.1007/s00464-020-08009-1

A novel biosynthetic scaffold mesh reinforcement affords the lowest hernia recurrence in the highest-risk patients

Surg Endosc. 2021 Sep;35(9):5173-5178. doi: 10.1007/s00464-020-08009-1. Epub 2020 Sep 24.

Authors

Mitchell J Parker¹, Rachel C Kim¹, Martin Barrio¹, Juan Socas¹, Lawrence R Reed¹, Attila Nakeeb¹, Michael G House¹, Eugene P Ceppa²

Affiliations

¹ Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH541, Indianapolis, IN, 46202, USA.
² Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH541, Indianapolis, IN, 46202, USA. eceppa@iupui.edu.

PMID: 32970208
DOI: 10.1007/s00464-020-08009-1

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.

Keywords: Biosynthetic hybrid mesh; Contaminated ventral hernia repair; Synthetic mesh; TELA bio OviTex; Ventral hernia repair.

MeSH terms

Hernia, Ventral* / surgery
Herniorrhaphy / adverse effects
Humans
Retrospective Studies
Surgical Mesh*
Treatment Outcome