K. Yuen1, S. Millikan1, J. Smolevitz1, M. Thaqi2, R. A. Jacobson1, K. W. Millikan1 1Rush University Medical Center,Department Of General Surgery,Chicago, IL, USA 2University Of Missouri,Department Of Surgery,Columbia, MO, USA
Introduction:
The separation of components (SOC) technique has improved outcomes in complex ventral hernia repair (VHR) since its inception. As the technique is relatively novel, unrealized gains in both outcomes and value likely exist. A recent consensus statement identified investigation into choice of mesh material as a needed future study. Our group recently reported low recurrence rates utilizing a biologic mesh onlay technique in VHR with SOC. While effective, the use of biologic mesh adds significant cost to patients and providers. In theory, synthetic absorbable mesh offers similar biological activity and repair strength at a lower cost than biologic mesh. We designed the current study to test the hypothesis that similar recurrence rates and safety could be achieved in VHR with SOC utilizing a synthetic absorbable mesh onlay compared to the same procedure performed with biologic mesh.
Methods:
Retrospective cohort study of patients undergoing VHR with SOC utilizing a mesh onlay with biologic (Bio) vs synthetic absorbable (SA) mesh performed by two surgeons at one institution over eight years. Standard anterior component separation with midline fascial closure and mesh onlay was used in all patients. Biologic mesh were allomax type (Bard Davol, Murray Hill, NJ) and synthetic absorbable mesh were phasix (Bard Davol). Cohorts were staggered temporally – the allomax cohort operations took placed between 2008 and 2013, while the phasix cohort operations took place between 2013 and 2015. The primary endpoint was hernia recurrence; secondary endpoints were wound complications including infection, seroma and skin necrosis. Follow up took place in the clinical setting and recurrence was determined on history and physical exam. Statistical significance was determined using student’s t-test and two proportion z-test where applicable.
Results:
188 patients were identified (103 Bio, 75 SA). Average BMI was 36.2 Bio vs 37.2 SA, p=0.45. Percent female was 60.2% Bio vs 60.0% SA, p=1. Average age was 56.1 Bio vs 53.5 SA, p=0.11. 16.0% of Bio patients underwent concomitant panniculecomy versus 59.1% of SA patients, p<.001. Mean follow up was 65.1 months Bio vs 22.4 months SA.
Overall recurrence at the end of the study period was 6.91% (13/188); recurrence using Bio was 6.80% (7/103) versus 8.00% (6/75) using SA, p=0.63. Overall rate of wound complications was 43.7% (45/103) Bio vs 46.7% (35/75) SA, p=0.67.
Conclusion:
Recurrence rates and wound complications were similar between patients receiving biologic and non-biologic synthetic mesh repairs. Our results show relatively low recurrence in each group compared to prior studies, particularly in obese individuals. In light of potential cost savings and equivalent safety and efficacy, non-biologic synthetic absorbable mesh should be considered for regular use in VHR with SOC.