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P035: THE ROLE OF A SLOWLY FULLY ABSORBABLE BIOSYNTHETIC POLY-4-HYDROXYBUTYRATE MESH IN VHWG GRADE 3 INCISIONAL HERNIA REPAIR: EARLY RESULTS IN 24 PATIENTS
Grigoris Chatzimavroudis, MD, MSc, PhD1; Nikolaos Voloudakis2; Georgia Kotoreni2; Stefanos Atmatzidis2; Vasilis Papaziogas2; 12nd Surgical Department, G.Gennimatas General Hospital, School of Medicine, Aristotle University of Thessaloniki and European Interbalkan Medical Center; 22nd Surgical Department, G.Gennimatas General Hospital, School of Medicine, Aristotle University of Thessaloniki
Introduction: According to the guidelines, biologic meshes are considered the optimal type of mesh for the repair of abdominal wall hernias in contaminated or dirty surgical fields, especially in terms of safety. However, the long-term results of their use have not been very encouraging regarding hernia recurrence and surgical site infection. Moreover, it should be kept in mind their high cost. During the last decade a new category of meshes, the fully absorbable biosynthetic meshes, has launched into the market of hernia repair that might be a good option for this subgroup of patients. Among them, the slowly fully absorbable biosynthetic poly-4-hydroxybutyrate (P4HB) mesh looks promising based on both the preclinical and clinical data. The purpose of this retrospective study is to present the early results of the management of abdominal wall hernias in non-clean field using this type of mesh.
Patients and methods: Between May 2016 and February 2020, 24 patients [13 men /11 women), classified as Grade 3 according to the modified Ventral Hernia Working Group (VHWG) classification system, underwent incisional hernia repair with the use of P4HB mesh. Patient’s demographics, co-morbidities, CDC surgical wound classification, type of hernia repair, surgical site occurrences (SSOs) and recurrence had been prospectively recorded and were included in the final data analysis.
Results: The median BMI of the patients was 31 [range 24-41) and the median age was 64 years (range 38-86). Twenty-two out of the 24 patients (91.7%) had one or more co-morbidities. Regarding the type of operation, all patients (24/24) underwent hernia repair with open techniques. More specifically, one patient (4.2%) underwent underlay repair, 20 patients (83.3%) underwent retromuscular repair (Rives-Stoppa=3 and posterior component separation with transversus abdominis release=20) and 3 patients (12.5%) sandwich repair (retromuscular+onlay=2 patients and underlay+onlay=1 patient). According to the CDC surgical wound classification system, nine cases were classified as class II/clean-contaminated (37.5%), seven as class III/contaminated (29.2%) and eight as dirty (33.3%). In relation to postoperative complications, SSOs were observed in only three patients (12.5%). More specifically, one patient (4.2%) presented seroma and two patients (8.3%) developed surgical site infections. It should be mentioned that both cases with surgical site infection were considered as clean-contaminated (incisional hernia repair + stoma takedown). All patients with postoperative SSOs were successfully treated conservatively. None of the patients required P4HB mesh excision or re-operation. With a median follow-up of 21 months (range 2-46), none of the patients has presented hernia recurrence so far.
Conclusions: The early results of the use of P4HB mesh in the repair of abdominal wall hernias in non-clean surgical fields are extremely promising concerning both safety and effectiveness. Biosynthetic slowly fully absorbable P4HB mesh seems a reliable option for the treatment of these complex hernias.
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