Five-Year Follow-Up of a Slowly Resorbable Biosynthetic P4HB Mesh (Phasix) in VHWG Grade 3 Incisional Hernia Repair

L M Van den Dop; M M J Van Rooijen; T Tollens; L N Jørgensen; T S De Vries-Reilingh; G Piessen; F Köckerling; M Miserez; M Dean; F Berrevoet; B Dousset; H L Van Westreenen; F Gossetti; G W M Tetteroo; A Koch; M F Boomsma; J F Lange; J Jeekel

doi:10.1097/AS9.0000000000000366

Five-Year Follow-Up of a Slowly Resorbable Biosynthetic P4HB Mesh (Phasix) in VHWG Grade 3 Incisional Hernia Repair

Ann Surg Open. 2023 Nov 28;4(4):e366. doi: 10.1097/AS9.0000000000000366. eCollection 2023 Dec.

Authors

L M Van den Dop¹, M M J Van Rooijen¹, T Tollens², L N Jørgensen³, T S De Vries-Reilingh⁴, G Piessen⁵, F Köckerling⁶, M Miserez⁷, M Dean⁸, F Berrevoet⁹, B Dousset¹⁰, H L Van Westreenen¹¹, F Gossetti¹², G W M Tetteroo¹³, A Koch¹⁴, M F Boomsma¹⁵, J F Lange¹, J Jeekel¹

Affiliations

¹ From the Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
² Department of Surgery, Imelda Hospital, Bonheiden, Belgium.
³ Department of Surgery, Bispebjerg Hospital, Copenhagen, Denmark.
⁴ Department of Surgery, Elkerliek Hospital, Helmond, the Netherlands.
⁵ Department of Surgery, University Hospital Lille, Lille, France.
⁶ Department of Surgery, Vivantes Klinikum Spandau, Berlin, Germany.
⁷ Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium.
⁸ Department of Surgery, University College London Hospital, London, United Kingdom.
⁹ Department of Surgery, University Hospital Gent, Gent, Belgium.
¹⁰ Department of Surgery, Hôpital Cochin, Paris, France.
¹¹ Department of Surgery, Isala Hospital, Zwolle, the Netherlands.
¹² Department of Surgery, Università di Roma Sapienza, Rome, Italy.
¹³ Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands.
¹⁴ Department of Surgery, Chirurgische Praxis Ärztehaus, Cottbus, Germany.
¹⁵ Department of Radiology, Isala hospital, Zwolle, the Netherlands.

Abstract

Objective: To assess the 5-year recurrence rate of incisional hernia repair in Ventral Hernia Working Group (VHWG) 3 hernia with a slowly resorbable mesh.

Summary background data: Incisional hernia recurs frequently after initial repair. In potentially contaminated hernia, recurrences rise to 40%. Recently, the biosynthetic Phasix mesh has been developed that is resorbed in 12-18 months. Resorbable meshes might be a solution for incisional hernia repair to decrease short- and long-term (mesh) complications. However, long-term outcomes after resorption are scarce.

Methods: Patients with VHWG grade 3 incisional midline hernia, who participated in the Phasix trial (Clinilcaltrials.gov: NCT02720042) were included by means of physical examination and computed tomography (CT). Primary outcome was hernia recurrence; secondary outcomes comprised of long-term mesh complications, reoperations, and abdominal wall pain [visual analogue score (VAS): 0-10].

Results: In total, 61/84 (72.6%) patients were seen. Median follow-up time was 60.0 [interquartile range (IQR): 55-64] months. CT scan was made in 39 patients (68.4%). A recurrence rate of 15.9% (95% confidence interval: 6.9-24.8) was calculated after 5 years. Four new recurrences (6.6%) were found between 2 and 5 years. Two were asymptomatic. In total, 13/84 recurrences were found. No long-term mesh complications and/or interventions occurred. VAS scores were 0 (IQR: 0-2).

Conclusions: Hernia repair with Phasix mesh in high-risk patients (VHWG 3, body mass index >28) demonstrated a recurrence rate of 15.9%, low pain scores, no mesh-related complications or reoperations for chronic pain between the 2- and 5-year follow-up. Four new recurrences occurred, 2 were asymptomatic. The poly-4-hydroxybutyrate mesh is a safe mesh for hernia repair in VHWG 3 patients, which avoids long-term mesh complications like pain and mesh infection.

Keywords: CT scan; biosynthetic mesh; incisional hernia; long-term; recurrence.