Comparative Long-Term Performance of Biologic, Synthetic, and Long-Acting Resorbable Meshes in Ventral Hernia Repair: Population Survival Kinetics Approach.

Abstract

Background: Long term follow-up outcomes of ventral hernia repairs (VHRs) with meshes are unavailable. Knowledge of these meshes at distant timepoints will be useful in selecting optimal mesh for VHRs. Our study aims to develop a highly accurate model to validate and predict long-term recurrence data of open VHRs and further determine the optimal timing of follow up for different VHRs with different meshes.

Study design: Using population survival kinetics, one-phase non-linear regression analysis (NLRA) was used to determine the overall time-to-recurrence for repairs with all three mesh types. Time-to-recurrence was used to validate and predict the year-over-year recurrence data for each specific mesh type.

Results: The model found the median overall time-to-recurrence to be longest for long-acting resorbable meshes (166.4 months), followed by synthetic meshes (132.1 months), and shortest for biologic meshes (80 months). At 5 years, about 41% of VHRs with biologic meshes, 27% with synthetic meshes, and 22% with long-acting resorbable meshes are expected to fail due to recurrence; at 10 years, these rates will rise to 65%, 47%, and 39%, respectively. Biologic meshes will have the highest proportion of "at-risk" repairs (42%). At 15-years post-repair 98-99% of the remaining unrecurred VHRs in the biologic and synthetic meshes will remain intact beyond that timepoint. Patients who had VHR with biologic and synthetic mesh should be evaluated for recurrence every 6 months for 2 years, then yearly up to 15 years. Patients repaired with long-acting resorbable meshes should be evaluated for recurrence starting at 12-18 months post-repair, then yearly.

Conclusions: We demonstrate the first application of population survival kinetics in the surgery literature. Long-acting resorbable meshes have the longest time-to-recurrence and the lowest recurrence rates over 5 and 10 years, suggesting superior long-term performance compared to synthetic and biologic meshes.