Biologic mesh is non-inferior to synthetic mesh in CDC class 1 & 2 open abdominal wall reconstruction

Although recommendations help guide surgeons’ mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.

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P014 COMPARATIVE EFFECTIVENESS OF RESORBABLE SYNTHETIC ONLAY AND BIOLOGIC INTRAPERITONEAL MESH FOR ABDOMINAL WALL RECONSTRUCTION: A 2-YEAR MATCHED PAIR ANALYSIS

British Journal of Surgery ◽

10.1093/bjs/znab395.013 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Sammy Othman ◽

Adrienne Christopher ◽

Viren Patel ◽

Hanna Jia ◽

Joseph Mellia ◽

...

Keyword(s):

Abdominal Wall ◽

Relative Effectiveness ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Biologic Mesh ◽

Matched Pair ◽

Recurrence Rates ◽

Matched Pair Analysis ◽

Operative Outcomes ◽

Clean Contaminated

Abstract Aim The literature currently lacks comparative studies examining the relative effectiveness of anatomic planes and mesh selection when combating abdominal wall reconstruction (AWR), particularly when the retrorectus sublay space is not available. The aim of this study was to examine the efficacy of resorbable synthetic mesh onlay (RSOM) plane against biologic mesh in the intraperionteal plane (BIPM). Methods A single center, two surgeon, 5-year retrospective review (2014-2019) was performed examining subjects who underwent AWR in the onlay plane with resorbable synthetic mesh or the intraperitoneal plane with biologic mesh. A matched paired analysis was conducted. Data examining demographic characteristics, intraoperative variables, post-operative outcomes, and costs were analyzed. Results A total of 88 subjects (44 per group) were identified (median follow-up: 24.5 months). The mean age was 57.7 years, with a mean BMI of 30.4 kg/m2. The average defect size was 292 ± 237 cm2, with most wounds being clean-contaminated (48.9%), and 55% having prior failed repair. RSOM subjects were significantly less likely (4.5%) to experience recurrence compared to BIPM (22.7%; p<0.026.). Additionally, RSOM suffered less post-operative surgical site occurrences (18.2% vs. 40.9%;p<0.019) and required fewer procedural interventions (11.4% vs. 36.4%;p<0.011). RSOM was also associated with significantly less total costs ($16,658 ± 14,930) compared to BIPM ($27,645 ± 16,864;p<0.001). Conclusion When faced with hernia repair, the selection of resorbable synthetic mesh in the onlay plane may be preferable to biologic mesh place in the intraperitoneal plane due to lower long-term recurrence rates, surgical site complications, and costs.

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Commentary on ‘Perioperative complications of complex abdominal wall reconstruction with biologic mesh: A pooled retrospective cohort analysis of cohort of 220 patients from two academic centers’

International Journal of Surgery ◽

10.1016/j.ijsu.2020.01.123 ◽

2020 ◽

Vol 75 ◽

pp. 53-54

Author(s):

Meer M. Chisthi

Keyword(s):

Abdominal Wall ◽

Retrospective Cohort ◽

Perioperative Complications ◽

Cohort Analysis ◽

Abdominal Wall Reconstruction ◽

Biologic Mesh ◽

Retrospective Cohort Analysis

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P011 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: A CASE-CONTROL SERIES

British Journal of Surgery ◽

10.1093/bjs/znab395.010 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Claudio Birolini ◽

Eduardo Tanaka ◽

Jocielle Miranda ◽

Abel Murakami ◽

Edivaldo Utiyama

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Tissue Response ◽

Abdominal Wall Defects ◽

Chronic Infections ◽

Control Series ◽

Elective Setting ◽

Abdominal Operations ◽

Low Incidence

Abstract Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods A prospective clinical trial started in 2016 and designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and a longer operative and anesthesia time. At 30-days, surgical site occurrences were observed in 18 (47.4%) AI vs. 17 (44.7%) CC; surgical site infection occurred in 4 (10.4%) AI vs. 6 (15.8%) CC, and a higher number of procedural interventions were required in the CC group, 15.8% AI vs. 28.9% CC. At 6-months follow-up, no chronic infections or hernia recurrences were observed in both groups. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

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