Open, complex abdominal wall reconstruction with synthetic versus biologic mesh: Outcomes with a minimum of 5-year follow-up.

INTRODUCTION

Reported outcomes for synthetic mesh versus biologic mesh in open abdominal wall reconstruction vary widely and are influenced by mesh type, location, fascial closure, wound complications, and patient characteristics. Little comparative data controlling for these variables or long-term results exists. This study compared outcomes between synthetic mesh and biologic mesh with >5 years of follow-up.

METHODS

A prospectively maintained database was queried for open abdominal wall reconstruction with >5 years of follow-up. A 1:1 propensity score match was performed based on age, body mass index, tobacco status, diabetes, American Society of Anesthesiologists classification, and defect. Standard descriptive and comparative statistics were calculated.

RESULTS

The 76 pairs generated were well balanced for age, body mass index, comorbidities, American Society of Anesthesiologists score, and rate of recurrent hernia. Wound class varied significantly (Centers for Disease Control and Prevention class 2-4: 15.8% vs 81.6%; P < .001). Defect size (244.6± 267.0 cm2 vs 254.1 ± 141.4 cm2; P = .0866) and mesh placement (preperitoneal 97.6% vs 100.0%; P = .497) were similar; mesh size differed (943.8 ± 415.0 cm2 vs 581.5 ± 297.4 cm2; P < .001). There were no differences in component separation or fascial closure. Biologic mesh had increased operative time (189.9 ± 73.2 minutes vs 229.3.5 ± 95.7 minutes; P = .010), operating room charges ($12,682 ± $7,352 vs $22,293 ± $14,373; P < .001), and total charges ($58,265 ± $27,712 vs $119,740 ± $69,670; P < .001). Delayed primary closure was more frequent with biologic mesh secondary to wound contamination (1.3% vs 30.3%; P < .001). Postoperatively, there were no differences in wound dehiscence (11.8% vs 11.8%), infection (0.5% vs 14.5%), seroma (17.1% vs 14.5%), mesh infection (3.9% vs 2.6%), or hernia recurrence (11.8% vs 9.2%) (all P > .05). Follow-up averaged >7 years (3.2 ± 25.2 months vs 86.1 ± 24.5 months).

CONCLUSION

In propensity-matched patients with complex, large abdominal wall reconstructions with at least 5 years of follow-up, biologic mesh and synthetic mesh yielded equivalent hernia recurrence and wound complication outcomes. Biologic mesh is as effective as synthetic mesh in abdominal wall reconstruction despite being more frequently used in a contaminated setting.