{"title":"Outcomes of Long-Term Absorbable Mesh Use for Ventral Hernia Repair in Immunosuppressed Patients.","authors":"Gaëtan-Romain Joliat, Benoit Romain, Guillaume Passot","doi":"10.1002/wjs.70609","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Immunosuppressed patients are more at risk of perioperative infections. In case of ventral hernia repair, the use of a long-term absorbable mesh could potentially decrease the infectious risk in these patients. This study aimed to assess the short- and mid-term outcomes of ventral hernia repair with long-term absorbable mesh in immunosuppressed and non-immunosuppressed patients compared with permanent mesh in non-immunosuppressed patients.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in two tertiary centers in France. Consecutive patients who underwent ventral hernia repair with a long-term absorbable (poly-4-hydroxybutyrate, P4HB) mesh between 2017 and 2024 were included. Immunosuppression was defined as a decreased immunity level caused by a disease or medication. Outcomes of these patients were compared to non-immunosuppressed patients who underwent ventral hernia repair with P4HB mesh and with synthetic mesh.</p><p><strong>Results: </strong>A total of 465 patients were included: 27 in the immunosuppressed group with P4HB mesh, 232 non-immunosuppressed patients with P4HB mesh, and 206 non-immunosuppressed patients with synthetic mesh. Among patients with P4HB mesh, no differences in postoperative outcomes were found between the immunosuppressed and non-immunosuppressed groups (mean follow-up: 15 months, 95% CI 12-17). When comparing immunosuppressed patients with P4HB to non-immunosuppressed patients with synthetic mesh, the morbidity rate was higher in immunosuppressed patients (12/27 = 44% vs. 38/206 = 18%, p = 0.002), while surgical site infection, mesh infection, or recurrence rates were similar (mean follow-up: 19 months, 95% CI 16-23). Immunosuppression was not found as a predictor of surgical site infection (OR 5.0, 95% CI 0.7-10.0, p = 0.091).</p><p><strong>Conclusions: </strong>Immunosuppressed patients with P4HB mesh had similar short- and mid-term infectious complications to non-immunosuppressed patients. Long-term recurrence rates remain to be evaluated.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/wjs.70609","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Immunosuppressed patients are more at risk of perioperative infections. In case of ventral hernia repair, the use of a long-term absorbable mesh could potentially decrease the infectious risk in these patients. This study aimed to assess the short- and mid-term outcomes of ventral hernia repair with long-term absorbable mesh in immunosuppressed and non-immunosuppressed patients compared with permanent mesh in non-immunosuppressed patients.
Methods: A retrospective cohort study was conducted in two tertiary centers in France. Consecutive patients who underwent ventral hernia repair with a long-term absorbable (poly-4-hydroxybutyrate, P4HB) mesh between 2017 and 2024 were included. Immunosuppression was defined as a decreased immunity level caused by a disease or medication. Outcomes of these patients were compared to non-immunosuppressed patients who underwent ventral hernia repair with P4HB mesh and with synthetic mesh.
Results: A total of 465 patients were included: 27 in the immunosuppressed group with P4HB mesh, 232 non-immunosuppressed patients with P4HB mesh, and 206 non-immunosuppressed patients with synthetic mesh. Among patients with P4HB mesh, no differences in postoperative outcomes were found between the immunosuppressed and non-immunosuppressed groups (mean follow-up: 15 months, 95% CI 12-17). When comparing immunosuppressed patients with P4HB to non-immunosuppressed patients with synthetic mesh, the morbidity rate was higher in immunosuppressed patients (12/27 = 44% vs. 38/206 = 18%, p = 0.002), while surgical site infection, mesh infection, or recurrence rates were similar (mean follow-up: 19 months, 95% CI 16-23). Immunosuppression was not found as a predictor of surgical site infection (OR 5.0, 95% CI 0.7-10.0, p = 0.091).
Conclusions: Immunosuppressed patients with P4HB mesh had similar short- and mid-term infectious complications to non-immunosuppressed patients. Long-term recurrence rates remain to be evaluated.
背景：免疫抑制患者围手术期感染的风险更高。在腹疝修补的病例中，使用长期可吸收补片可以潜在地降低这些患者的感染风险。本研究旨在评估在免疫抑制和非免疫抑制患者中使用长期可吸收补片与在非免疫抑制患者中使用永久性补片进行腹疝修补的短期和中期结果。方法：在法国两所高等教育中心进行回顾性队列研究。纳入了2017年至2024年间连续接受长期可吸收（聚4-羟基丁酸酯，P4HB）补片腹疝修补的患者。免疫抑制被定义为由疾病或药物引起的免疫水平下降。将这些患者的结果与使用P4HB补片和合成补片进行腹疝修补的非免疫抑制患者进行比较。结果：共纳入465例患者：P4HB补片免疫抑制组27例，P4HB补片非免疫抑制组232例，合成补片非免疫抑制组206例。在使用P4HB补片的患者中，免疫抑制组和非免疫抑制组的术后结局没有差异（平均随访时间：15个月，95% CI 12-17）。将P4HB免疫抑制患者与使用合成补片的非免疫抑制患者进行比较，免疫抑制患者的发病率更高（12/27 = 44% vs. 38/206 = 18%, p = 0.002），而手术部位感染、补片感染或复发率相似（平均随访19个月，95% CI 16-23）。免疫抑制未被发现是手术部位感染的预测因子（OR 5.0, 95% CI 0.7-10.0, p = 0.091）。结论：P4HB补片免疫抑制患者的中短期感染并发症与非免疫抑制患者相似。长期复发率仍有待评估。
期刊介绍：
World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.
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