title: Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs.
abstract: Contaminated operative fields pose significant challenges for surgeons performing ventral hernia repair. Although biologic meshes have been utilized increasingly in these fields, recent evidence suggests that synthetic meshes represent a viable option. We analyzed the outcomes of biologic and synthetic mesh utilized in patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields.
  
  
  
  We conducted a multicenter, retrospective review of patients undergoing open ventral hernia repair in clean-contaminated/contaminated fields using biologic or synthetic mesh. Patient and hernia details were characterized. Primary outcomes included 90-day surgical site event, surgical site infection, and hernia recurrence.
  
  
  
  A total of 126 patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields (69 biologic and 57 synthetic meshes) were analyzed. Groups were similar in both patient and hernia characteristics. There were 13 (22.8%) surgical site events in the synthetic cohort compared to 29 (42.0%) in the biologic cohort, P = .024. Similarly, surgical site infections were less frequent in the synthetic group, with 7 (12.3%) vs 22 (31.9%), P = .01. With a mean follow-up of 20 months, there were more recurrences in the biologic group: 15 (26.3%) vs 4 (8.9%) in the synthetic group, P = .039.
  
  
  
  The choice of mesh for clean-contaminated/contaminated ventral hernia repair remains debatable. We demonstrated that using synthetic sublay mesh resulted in a significantly lower wound morbidity and more durable outcomes versus a similar cohort of biologic repairs. This is likely secondary to improved bacterial clearance and faster integration of macroporous synthetics. Overall, our findings not only support suitability of synthetic mesh in contaminated settings but also challenge the purported advantage of biologics in clean-contaminated/contaminated ventral hernia repairs.
authors.affiliation: Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Arnab
authors.initials: A
authors.lastname: Majumder
authors.affiliation: Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State University Hershey Medical Center, Hershey, PA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Winder
authors.affiliation: Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Yuxiang
authors.initials: Y
authors.lastname: Wen
authors.affiliation: Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State University Hershey Medical Center, Hershey, PA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Pauli
authors.affiliation: Department of General Surgery, Anne Arundel Medical Center, Annapolis, MD.
authors.forename: Igor
authors.initials: I
authors.lastname: Belyansky
authors.affiliation: Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH. Electronic address: yuri.novitsky@uhhospitals.org.
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
mesh_terms: D000328:Adult; D001688:Biological Products; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020959:Polyethylene; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D001688:Biological Products; D020959:Polyethylene