Biosynthetic compared with synthetic mesh in retrorectus ventral hernia repair: A matched analysis with 3-year outcomes.

Abstract

<h4>Introduction</h4>The comparative effectiveness of biosynthetic and synthetic mesh in ventral hernia repair remains an area of ongoing inquiry. This study aimed to evaluate long-term outcomes after retrorectus ventral hernia repair using either poly-4-hydroxybutyrate biosynthetic (Phasix) or uncoated polypropylene synthetic mesh (Marlex) in clean wounds.<h4>Methods</h4>This single-center, retrospective cohort study included patients who underwent retrorectus ventral hernia repair with biosynthetic or synthetic mesh in clean wounds between 2015 and 2021 who were followed up to hernia recurrence or 3 years. Optimal full matching using Mahalanobis distance incorporating age, body mass index, transversus abdominus release, and American Society of Anesthesiologists classification was performed.<h4>Results</h4>A total of 160 patients (49 synthetic, 111 biosynthetic) were included, with a median age and body mass index of 62 years old (interquartile range, 52.8-72.0 years) and 33.7 kg/m² (28.4-39.1 kg/m²), respectively. After matching, baseline characteristics, comorbidities, and transversus abdominus release use rates were comparable between groups; however, biosynthetic group had a greater average defect size (220 cm² vs 141 cm², P = .010). Hernia recurrence at 3 years did not differ significantly between the biosynthetic and synthetic mesh groups (3.3% vs 7.0%, respectively; log-rank P = .4). Similarly, there were no significant differences in SSOs (27% vs 37%, P = .3), readmission rates (17% vs 21%, P = .6), surgical-site occurrences requiring procedural intervention (11% vs 14%, P = .7), or all-cause reoperation rates (17% vs 18%, P = .9).<h4>Conclusion</h4>In this matched cohort study, poly-4-hydroxybutyrate and uncoated polypropylene synthetic mesh demonstrated comparable long-term outcomes in retrorectus ventral hernia repair for clean wounds.