Analysis of polypropylene meshes with embedded silver ions in ventral hernia repair: can they be used in different grades of contamination?

IF 2.4 2区医学 Q1 SURGERY

Hernia Pub Date : 2025-09-03 DOI:10.1007/s10029-025-03450-4

José Bueno-Lledó, Omar Carreño-Sáenz, Providencia García-Pastor, José Antonio Pereira-Rodríguez, Carlos Hoyuela-Alonso, Carles Olona-Casas, Salvador Pous-Serrano

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引用次数: 0

Abstract

Background: This study aimed to analyze the outcomes of patients undergoing ventral hernia repair (VHR) with a polypropylene mesh with embedded silver ions (PSM) in the context of different degrees of contamination, compared to standard conventional macroporous polypropylene mesh (PPL).

Methods: From May 2019 to October 2023, a retrospective comparative analysis of patients who underwent elective or urgent VHR with a SilverMesh (PSM group) versus standard macroporous polypropylene mesh (PPL group), based on the Spanish Hernia registry (EVEREG). The exclusion criteria were other PSM indications (groin hernia, prophylaxis) and the use of composite meshes or any material different to PPL. Each Hospital participating in the registry applied its own preoperative antibiotic protocol. The field contamination degree was assessed according the Centers for Disease Control (CDC) classification criteria. Epidemiological data, hernia characteristics, surgical and postoperative variables (Clavien-Dindo classification) of these patients were analysed.

Results: From May 2019 to October 2023, PPL group included 446 cases and PSM group 206 cases. The number of PPL cases were reduced from 2655 to 446, to try and match suitable similar cases in both groups. In PSM group, smoking (28.6% vs. 20.6%; p = 0.000), COPD (23.3% vs. 16.9%; p = 0.050), ASA class III-IV (35% vs. 29.2%; p = 0.001), prehabilitation with BTA (16% vs. 4%; p = 0.000) and PPP (5.8% vs. 0.9%; p = 0.000), and W2-W3 hernias (79.9% vs. 53.2%; p = 0.000) were more frequent than PPL group. In PSM group, complex techniques of VHR like RSR and CST (61% vs. 48%; p = 0.000), average duration of surgery (91.7 vs. 69.9 min; p = 0.032) and mean length of stay (5.4 vs. 4.7 days; p = 0.034) were more frequent than PPL group. The overall rate of short-term SSO was slightly lower in PSM than PPL group (30.5% vs. 33.7%; p = 0.155) though statistically insignificant. No mesh infection was reported in PSM group versus 7 cases in PPL group, although this was not statistically significant.

Conclusions: The use of PSM for VHR in different degrees of contamination and without a significant superiority over PPL, leads to favourable results, especially in overall rate of SSO and CMI, in patients with preoperative risk factors, large hernias and complex hernia repairs. Being the first clinical study performed with this prosthesis, further comparative studies with longer follow-up are needed to explore further.

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嵌埋银离子聚丙烯网片在腹疝修补中的应用分析：能否在不同污染等级下使用？

背景：本研究旨在分析在不同污染程度的情况下，使用嵌入银离子的聚丙烯补片（PSM）进行腹疝修补（VHR）的患者的结果，并与标准的传统大孔聚丙烯补片（PPL）进行比较。方法：基于西班牙疝登记（EVEREG），从2019年5月到2023年10月，回顾性比较分析了使用SilverMesh （PSM组）和标准大孔聚丙烯补片（PPL组）进行选择性或紧急VHR的患者。排除标准是其他PSM适应症（腹股沟疝，预防）和使用复合网片或任何不同于PPL的材料。参与登记的每家医院采用自己的术前抗生素方案。现场污染程度根据疾病控制中心（CDC）分类标准进行评估。分析这些患者的流行病学资料、疝特征、手术和术后变量（Clavien-Dindo分类）。结果：2019年5月至2023年10月，PPL组446例，PSM组206例。PPL病例数从2655例减少到446例，试图匹配两组合适的相似病例。在PSM组中，吸烟（28.6%比20.6%,p = 0.000）、COPD（23.3%比16.9%,p = 0.050）、ASA III-IV级（35%比29.2%,p = 0.001）、BTA预处理（16%比4%，p = 0.000）和PPP（5.8%比0.9%,p = 0.000）和W2-W3疝（79.9%比53.2%,p = 0.000）比PPL组更常见。PSM组RSR、CST等VHR复杂技术（61% vs. 48%, p = 0.000）、平均手术时间（91.7 vs. 69.9 min, p = 0.032）、平均住院时间（5.4 vs. 4.7 d, p = 0.034）均高于PPL组。PSM组短期SSO总体发生率略低于PPL组（30.5% vs. 33.7%, p = 0.155），但差异无统计学意义。PSM组无补片感染，PPL组7例，但差异无统计学意义。结论：在不同污染程度的VHR中使用PSM，在术前存在危险因素、大疝和复杂疝修补的患者中，PSM与PPL相比没有明显的优势，可获得良好的效果，特别是在SSO和CMI的总体发生率方面。作为首次使用该假体进行的临床研究，需要进一步进行更长时间随访的比较研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.