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P008: CHOICE OF HERNIA MESH FOR PATIENTS AT HIGHER THAN AVERAGE RISK FOR MESH-RELATED COMPLICATIONS
Desmond T Huynh, MD1; Maggie Diller, MD1; Negin Fadaee2; Shirin Towfigh, MD2; 1Cedars-Sinai Medical Center; 2Beverly Hills Hernia Center
INTRODUCTION: Certain patients are considered to be at higher than average risk for mesh-related complications. These include patients with autoimmune disorders as well as those who have already demonstrated mesh reaction or mesh material-related pain. Patients who react to or are at risk for reacting to pure synthetic mesh may have improved outcomes with biomaterial that has a lower inflammatory and immune potential. Reinforced biologic mesh (RBM) is a hybrid of a biologic with low inflammatory and immune potential and a minimal weave of permanent synthetic suture. The aim of this study is to evaluate the effectiveness of RBM in improving outcomes in this subgroup of patients.
METHODS: All patients undergoing hernia repair with RBM were evaluated for pain and mesh-related complications. Indications for RBM use were categorized as a) primary repair in at-risk patients with autoimmune disorders or chronic pain (“At-Risk”), b) replacement of synthetic mesh in patients diagnosed with systemic mesh reaction (“Reaction”), and c) replacement of synthetic mesh in patients with mesh material-related pain (“Pain”). Non-elective use of RBM, e.g., for mesh infection or in contaminated spaces, were excluded. Pain scores are presented as mean (range 0-10).
RESULTS: Thirty-two patients underwent hernia repair with RBM. The majority (26, 81%) underwent inguinal hernia repair. Mean long-term follow-up (LTF) was 5.5 months (range 0.03-31). All patients demonstrated significant reduction in pain score postoperatively:
The At-Risk group (n=16, 50%) had a reduction in pain score from 4.4 (1-7) preoperatively to 1.3 (0-3) postoperatively (p<0.001). The pain score in the Reaction group (n=9, 28%) reduced from 6.7 (4.5-9.5) to 2.9 (0-8, p=0.018). The pain score in the Pain group (n=7, 22%) reduced from 6.0 (4.5-7.5) to 2.0 (0-5, p=0.012). The greatest improvement in pain was among the patients in whom synthetic mesh was removed and replaced with RBM during the same operation (n=15, 46%) with mean preoperative pain score 6.4 (4.5-9.5) reduced to 2.3 (0-8) postoperatively.
All (100%) Reaction and Pain patients had resolution of their preoperative mesh material-related symptoms postoperatively. No (0%) patients demonstrated any RBM material-related symptoms. Complications (5, 16%) included 2 (6%) recurrences, 2 (6%) seromas, and 1 (3%) hematoma.
CONCLUSIONS: All patients considered to be at higher than average risk for mesh-related complications showed significant improvements in symptoms after hernia repair with RBM. The greatest benefit was seen among patients who had synthetic mesh removed and replaced with RBM at the same setting. These patients demonstrated systemic mesh reaction or mesh material-related pain preoperatively and were cured of those symptoms postoperatively. This supports our clinical suspicion that a mesh with lower inflammatory and immune potential can be used to address symptoms related to pure synthetic mesh material. Based on our experience, we have changed our practice and routinely offer RBM as an alternative to pure synthetic mesh in these patients. Meanwhile, we continue to assess our outcomes.
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