Mesh-related Outcomes of Biologic Versus Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias: A 5 to 10-year Analysis of a Randomized Controlled Trial.

Abstract

To determine the 5 to 10-year safety and durability outcomes of biologic versus synthetic mesh in contaminated ventral hernia repair. Recent randomized controlled trials have demonstrated the safety and efficacy of synthetic mesh in clean-contaminated and contaminated ventral hernia repairs, but follow-up has typically been limited to 2 years. Concerns persist regarding long-term outcomes of synthetic mesh beyond this initial period. A minimum 5-year follow-up analysis was conducted on 253 patients from our multicenter randomized controlled trial (NCT02451176). The primary outcome was cumulative long-term midline hernia recurrence risk. Secondary outcomes were long-term complications including mesh-related infection, excision, and reoperation. Follow-up was achieved in 80.2% (n=203) of patients with a median follow-up of 5.4 years (interquartile range: 2.1-6.8) and mean of 5.5 years (SD: 2.7). Synthetic mesh was associated with a significant reduction in midline hernia recurrence risk (hazard ratio=0.46, 95% CI: 0.25-0.86, P =0.015). The 5 to 10-year overall midline recurrence rate was 17.8%: 23.6% in the biologic group and 11.8% in the synthetic group, corresponding to an absolute risk reduction of 11.8% (95% CI: 2.1-21.4) with synthetic mesh. This advantage was primarily observed within the first 2 years with no significant difference in recurrence rates beyond 2 years. No new mesh infections or excisions occurred in either group beyond 2 years postoperatively. Three patients (1.2%) required intervention for ongoing wound-related issues. Synthetic mesh provides superior long-term recurrence outcomes without increased mesh-related complications in clean-contaminated and contaminated repairs when compared with biologic mesh.