Poly-4-hydroxybutyrate Mesh for Ventral Hernia Repairs: A Single-Surgeon Experience

Cody C Fowler; Kevin M Klifto; Larissa E Wietlisbach; Sammy Othman; Eric S Weiss; Benjamin Braslow; Stephen J Kovach

Poly-4-hydroxybutyrate Mesh for Ventral Hernia Repairs: A Single-Surgeon Experience

Eplasty. 2023 Aug 17:23:e48. eCollection 2023.

Authors

Cody C Fowler¹, Kevin M Klifto², Larissa E Wietlisbach³, Sammy Othman⁴, Eric S Weiss³, Benjamin Braslow⁵, Stephen J Kovach³

Affiliations

¹ Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York.
² Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri, Columbia, Missouri.
³ Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, New Hyde Park, New York.
⁵ Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

PMID: 37664812
PMCID: PMC10472442

Abstract

Background: Poly-4-hydroxybutyrate (P4HB) (Phasix) biosynthetic mesh was recently introduced as an alternative to synthetic and biologic meshes for ventral hernia repair (VHR). However, outcomes data are limited. This study aims to analyze outcomes of VHR with P4HB mesh and identify predictors of postoperative outcomes.

Methods: We performed a retrospective study of adults who underwent open VHR with P4HB by the senior author from 2014 to 2020 with >12 months' follow-up. Subgroup comparisons and multivariate logistic regression were performed.

Results: Inclusion criteria were met by 169 patients with a median of 15 months of follow-up. Overall, 21.9% had surgical site occurrences, 17.8% required reoperation, and 4.7% had recurrences. Patients with prior VHR (47.9%) experienced similar outcomes to those without. Patients with prior mesh infection (18.3%) had higher rates of postoperative mesh infection (6.5% vs 0.7%; P = .029) but did not have higher rates of reoperation. Retrorectus repairs (45.5%) had similar outcomes to onlay repairs (54.5%). Recurrence risk was increased by hypertension (odds ratio [OR] = 13.64; P = .046), immunosuppression (OR = 42.57; P = .004), and history of prior VHR (OR = 20.20; P = .014).

Conclusions: This study aimed to analyze outcomes of VHR augmented with P4HB mesh through retrospective review. VHR with P4HB mesh produces acceptable recurrence rates with favorable complication risks compared with biologic and synthetic meshes. Predictors of recurrence include a history of prior hernia repair, hypertension, and immunosuppression. A history of prior mesh infection seems to place patients at risk for developing subsequent infection but did not increase need for reoperation.

Keywords: Biosynthetic Mesh; Mesh; P4HB Mesh; Poly-4-Hydroxybutyrate; Repair; Ventral Hernia.

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