Abstract
Purpose
To analyze the postoperative morbidity and 1-year recurrence rate of incisional hernia repair using a biosynthetic long-term absorbable mesh in patients at higher risk of surgical infection in a contaminated surgical field.
Methods
All patients undergoing incisional hernia repair in a contaminated surgical field with the use of a biosynthetic long-term absorbable mesh (Phasix®) between May 2016 and September 2018 at six participating university centers were included in this retrospective cohort and were followed-up until September 2019. Regarding the risk of surgical infection, patients were classified according to the modified Ventral Hernia Working Group classification. Preoperative, operative and postoperative data were collected. All patients’ surgical site infections (SSIs) and occurrences (SSOs) and recurrence rates were the endpoints of the study.
Results
Two hundred and fifteen patients were included: 170 with mVHWG grade 3 (79%) and 45 with mVHWG grade 2 (21%). The SSI and SSO rates at 12 months were 22.3% and 39.5%, respectively. According to the Dindo–Clavien classification, 43 patients (20.0%) had at least one minor complication, and 57 patients (26.5%) had at least one major complication. Among the 121 patients (56.3%) having at least 1 year of follow-up, the clinical recurrence rate was 12.4%. Multivariate analysis showed that a concomitant gastrointestinal procedure was an independent risk factor for surgical infection (OR = 2.61), and an emergency setting was an independent risk factor for major complications (OR = 11.9).
Conclusion
The use of a biosynthetic absorbable mesh (Phasix®) is safe in a contaminated surgical field, with satisfying immediate postoperative and 1-year results.
Trial registration
The study is registered on Clinical Trial ID: NCT04132986.
Similar content being viewed by others
Availability of data and material
The study is registered on Clinical Trial ID: NCT04132986.
References
Holihan JL, Alawadi Z, Martindale RG et al (2015) Adverse events after ventral hernia repair: the vicious cycle of complications. J Am CollSurg 221:478–485
Luijendijk RW, Hop WC, van den Tol MP et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398
Burger JWA, Luijendijk RW, Hop WCJ et al (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583; discussion 583–585
Carbonell AM, Criss CN, Cobb WS et al (2013) Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am CollSurg 217:991–998
Choi JJ, Palaniappa NC, Dallas KB et al (2012) Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases. Ann Surg 255:176–180
Rosen MJ, Krpata DM, Ermlich B et al (2013) A 5-year clinical experience with single-staged repairs of infected and contaminated abdominal wall defects utilizing biologic mesh. Ann Surg 257:991–996
Primus FE, Harris HW (2013) A critical review of biologic mesh use in ventral hernia repairs under contaminated conditions. Hernia J Hernias Abdom Wall Surg 17:21–30
Doussot A, Abo-Alhassan F, Derbal S et al (2019) Indications and outcomes of a cross-linked porcine dermal collagen mesh (permacol) for complex abdominal wall reconstruction: a multicenter audit. World J Surg 43:791–797
Law-Ki C, Robineau C, Garnier N et al (2018) Cost of complex abdominal wall reconstruction with biological prostheses in a French public hospital. J ViscSurg 155:349–353
Martin DP, Badhwar A, Shah DV et al (2013) Characterization of poly-4-hydroxybutyrate mesh for hernia repair applications. J Surg Res 184:766–773
Scott JR, Deeken CR, Martindale RG et al (2016) Evaluation of a fully absorbable poly-4-hydroxybutyrate/absorbable barrier composite mesh in a porcine model of ventral hernia repair. SurgEndosc 30:3691–3701
Plymale MA, Davenport DL, Dugan A et al (2018) Ventral hernia repair with poly-4-hydroxybutyrate mesh. SurgEndosc 32:1689–1694
Roth JS, Anthone GJ, Selzer DJ et al (2018) Prospective evaluation of poly-4-hydroxybutyrate mesh in CDC class I/high-risk ventral and incisional hernia repair: 18-month follow-up. SurgEndosc 32:1929–1936
Buell JF, Sigmon D, Ducoin C et al (2017) Initial experience with biologic polymer scaffold (poly-4-hydroxybuturate) in complex abdominal wall reconstruction. Ann Surg 266:185–188
DeBord J, Novitsky Y, Fitzgibbons R et al (2018) SSI, SSO, SSE, SSOPI: the elusive language of complications in hernia surgery. Hernia J Hernias Abdom Wall Surg 22:737–738
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Kanters AE, Krpata DM, Blatnik JA et al (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am CollSurg 215:787–793
Romain B, Renard Y, Binquet C et al (2020) Recurrence after elective incisional hernia repair is more frequent than you think: an international prospective cohort from the French Society of Surgery. Surgery 168:125–134
Messa CA, Kozak G, Broach RB et al (2019) When the mesh goes away: an analysis of poly-4-hydroxybutyrate mesh for complex hernia repair. PlastReconstrSurg Glob Open 7:e2576
Levy AS, Bernstein JL, Premaratne ID et al (2020) Poly-4-hydroxybutyrate (PhasixTM) mesh onlay in complex abdominal wall repair. Surg Endosc. https://doi.org/10.1007/s00464-020-07601-9
van Rooijen MM, Jairam AP, Tollens T et al (2020) Outcomes of a new slowly resorbable biosynthetic mesh (PhasixTM) in potentially contaminated incisional hernias: a prospective, multi-center, single-arm trial. Int J SurgLondEngl 83:31–36
Huntington CR, Cox TC, Blair LJ et al (2016) Biologic mesh in ventral hernia repair: outcomes, recurrence, and charge analysis. Surgery 160:1517–1527
Itani KMF, Rosen M, Vargo D et al (2012) Prospective study of single-stage repair of contaminated hernias using a biologic porcine tissue matrix: the RICH study. Surgery 152:498–505
Pessaux P, Lermite E, Blezel E et al (2006) Predictive risk score for infection after inguinal hernia repair. Am J Surg 192:165–171
Kaafarani HMA, Kaufman D, Reda D et al (2010) Predictors of surgical site infection in laparoscopic and open ventral incisional herniorrhaphy. J Surg Res 163:229–234
Finan KR, Vick CC, Kiefe CI et al (2005) Predictors of wound infection in ventral hernia repair. Am J Surg 190:676–681
Rosen MJ, Bauer JJ, Harmaty M et al (2017) Multicenter, prospective, longitudinal study of the recurrence, surgical site infection, and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh: the COBRA study. Ann Surg 265:205–211
Bloemen A, van Dooren P, Huizinga BF et al (2012) Comparison of ultrasonography and physical examination in the diagnosis of incisional hernia in a prospective study. Hernia J Hernias Abdom Wall Surg 16:53–57
Köckerling F, Koch A, Lorenz R et al (2015) How long do we need to follow-up our hernia patients to find the real recurrence rate? Front Surg 2:24
Kroese LF, Sneiders D, Kleinrensink GJ et al (2018) Comparing different modalities for the diagnosis of incisional hernia: a systematic review. Hernia J Hernias Abdom Wall Surg 22:229–242
Romain B, Renard Y, Binquet C, Poghosyan T, Moszkowicz D, Gillion JF, Ortega-Deballon P (2019) Rapport de l’Association Française de Chirurgie des éventrations postopératoires
Pereira JA, López-Cano M, Hernández-Granados P et al (2016) Initial results of the National Registry of Incisional Hernia. CirugEsp 94:595–602
Atema JJ, de Vries FEE, Boermeester MA (2016) Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects. Am J Surg 212:982-995.e1
Praveen Raj P, Senthilnathan P, Kumaravel R et al (2012) Concomitant laparoscopic ventral hernia mesh repair and bariatric surgery: a retrospective study from a tertiary care center. ObesSurg 22:685–689
Ion D, Stoian RV, Bolocan A et al (1990) Is prosthetic repair of the abdominal wall in clean-contaminated surgical interventions possible? ChirBuchar Rom 2013(108):855–858
El-Gazzaz GH, Farag SH, El-Sayd MA et al (2012) The use of synthetic mesh in patients undergoing ventral hernia repair during colorectal resection: risk of infection and recurrence. Asian J Surg 35:149–153
Chan DL, Talbot ML, Chen Z et al (2014) Simultaneous ventral hernia repair in bariatric surgery. ANZ J Surg 84:581–583
Brahmbhatt R, Carter SA, Hicks SC et al (2014) Identifying risk factors for surgical site complications after laparoscopic ventral hernia repair: evaluation of the Ventral Hernia Working Group grading system. Surg Infect 15:187–193
Helton WS, Fisichella PM, Berger R et al (2005) Short-term outcomes with small intestinal submucosa for ventral abdominal hernia. Arch Surg Chic Ill 140:549–560; discussion 560–562
Iacco A, Adeyemo A, Riggs T et al (2014) Single institutional experience using biological mesh for abdominal wall reconstruction. Am J Surg 208:480–484; discussion 483–484
Krpata DM, Stein SL, Eston M et al (2013) Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. Am J Surg 205:354–358; discussion 358–359
Schachtrupp A, Wetter O, Höer J (2016) An implantable sensor device measuring suture tension dynamics: results of developmental and experimental work. Hernia J Hernias Abdom Wall Surg 20:601–606
Ireton JE, Unger JG, Rohrich RJ (2013) The role of wound healing and its everyday application in plastic surgery: a practical perspective and systematic review. PlastReconstrSurg Glob Open. 1(1):e10–e19
Funding
No grant support for the research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Ortega Deballon P., received grants from Bard/Beckton-Dickinson within the past 5 years. Dubuisson V., received grants from Bard/Beckton-Dickinson within the past 5 years. Renard Y., received grants from Bard/Beckton-Dickinson within the past 5 year. Bard/Beckton-Disckinson didn’t influence analysis and writing process of the study. D. Charleux-Muller, R. Hurel, T. Fabacher, C. Brigand, S. Rohr, S. Manfredelli, G. Passot, B. Romain authors declare that they have no conflict of interest.
Ethics approval
Compliance with ethical standards, for retrospective studies.
Human and animal rights
All participants gave their permission to participate to the study.
Informed consent
All participants provided informed consent prior to their participation.
Consent to participate and for publication
All authors have approved the manuscript and meet the requirements for authorship.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Charleux-Muller, D., Hurel, R., Fabacher, T. et al. Slowly absorbable mesh in contaminated incisional hernia repair: results of a French multicenter study. Hernia 25, 1051–1059 (2021). https://doi.org/10.1007/s10029-020-02366-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-020-02366-5