Synthetic Versus Biologic Mesh for Complex Open Ventral Hernia Repair: Three-Year Follow-Up of a Pilot Randomized Controlled Trial

Authors

Nalia H. Dhanani, McGovern Medical School at UTHealthFollow
Nicole B. Lyons, University of Miami Miller School of MedicineFollow
Kyung Hyun Lee, Center of Clinical Research and Evidence-Based Medicine, McGovern Medical School at UTHealth
Oscar A. Olavaarria, McGovern Medical School at UTHealthFollow
Aris R. Arakelians, University of Miami Miller School of MedicineFollow
Julie L. Holihan, McGovern Medical School at UTHealthFollow
Lillian S. Kao, McGovern Medical School at UTHealth
Ali Siddiqui, HCA Houston Healthcare KingwoodFollow
Connor Hogan, HCA Houston Healthcare KingwoodFollow
Tunmi Anwoju, HCA Houston Healthcare KingwoodFollow
Zuhair Ali, HCA Houston Healthcare KingwoodFollow
Mike K. Liang, HCA Houston Healthcare KingwoodFollow

Keywords

biologic mesh; synthetic mesh; surgical mesh; ventral hernia repair; ventral hernia; surgical site infection; surgical wound infection; randomized controlled trial

Disciplines

Surgery

Abstract

Background

Biologic mesh is often used in complex hernia repair, but there has been limited clinical evidence to date to support this practice. The aim of this study was to compare clinical and patient-reported outcomes of biologic versus synthetic mesh for complex open ventral hernia repair (OVHR) at 3 years.

Methods

Patients from a single center, randomized, controlled, pilot trial comparing biologic versus synthetic mesh in complex OVHR were followed for 3 years. The primary outcome focused on major complications, namely mesh infections, hernia recurrences, reoperations, and deaths. Secondary outcomes included surgical site infections, surgical site occurrences, and patient-reported outcomes. Outcomes were assessed using frequentist generalized linear models.

Results

A total of 87 patients (44 biologic mesh, 43 synthetic mesh) were randomized, and 61 patients (70%; 28 biologic and 33 synthetic) completed 3-year follow-up. Baseline demographics were similar in both groups. No significant differences were seen in major complications (50% vs 30%, P = .123), mesh infection (14% vs 3%, P = .144), recurrence (39% vs 24%, P = .214), reoperation (14% vs 9%, P = .531), or mortality (4% vs 0%, P = .459) between the 2 arms. A single death occurred as a result of bacteremia in a patient with hepatocellular carcinoma. Similarly, no significant differences were seen in secondary or patient-reported outcomes. Both groups demonstrated clinically important improvements in quality of life and pain scores at 3 years.

Conclusion

This study failed to find benefits with biologic mesh as opposed to synthetic mesh in complex OVHR at 3 years when comparing both clinical and patient-reported outcomes.

Recommended Citation

Dhanani, Nalia H.; Lyons, Nicole B.; Lee, Kyung Hyun; Olavaarria, Oscar A.; Arakelians, Aris R.; Holihan, Julie L.; Kao, Lillian S.; Siddiqui, Ali; Hogan, Connor; Anwoju, Tunmi; Ali, Zuhair; and Liang, Mike K. (2025) "Synthetic Versus Biologic Mesh for Complex Open Ventral Hernia Repair: Three-Year Follow-Up of a Pilot Randomized Controlled Trial," HCA Healthcare Journal of Medicine: Vol. 6: Iss. 1, Article 7.
DOI: 10.36518/2689-0216.1761
Available at: https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol6/iss1/7