Onlay Resorbable Biosynthetic Versus Underlay Biologic Mesh Ventral Hernia Repair in Contaminated Fields.

Abstract

Introduction: Abdominal wall reconstruction (AWR) with ventral hernia repair (VHR) in the setting of contamination poses unique and controversial challenges. The purpose of this study was to examine the efficacy of onlay resorbable biosynthetic mesh against underlay biologic mesh in contaminated VHR with AWR.

Methods: A single-center retrospective review from 2015 to 2021 was performed examining subjects who underwent VHR with AWR in contaminated fields (Centers for Disease Control wound class II-IV). A matched paired analysis based on age, body mass index, and Centers for Disease Control wound class was conducted among patients who utilized resorbable biosynthetic mesh in an onlay fashion and biologic mesh in an underlay fashion.

Results: A total of 94 patients (47 per group) underwent VHR with AWR in contaminated fields. Patients who utilized biosynthetic mesh had an average defect size of 314.56 ± 214.65 cm², required component separation (57.4%), and were often recurrent (61.7%). Majority of contamination were clean-contaminated (68.1%), followed by dirty/infected (19.1%), and contaminated (12.8%). Patients utilizing resorbable biosynthetic mesh experienced fewer surgical site occurrences (SSOs) (46.8% versus 72.3%, P < 0.05) and fewer SSO procedural interventions (19.1% versus 38.4%, P < 0.05). Patients with biosynthetic mesh had fewer hernia recurrences compared to biologic mesh use; however, was not statistically significant (14.9% versus 30.4%, P = 0.07), with a mean follow-up of 25.73 ± 18.66 mo.

Conclusions: Utilization of resorbable biosynthetic mesh may be preferable to biologic mesh in contaminated fields due to lower rates of SSOs and interventions, ultimately reducing the postoperative clinical and financial burden for this patient population.