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Spurzem GJ, Broderick RC, Li JZ, Sandler BJ, Horgan S, Jacobsen GR. Maximizing mesh mileage: evaluating the long-term performance of a novel hybrid mesh for ventral hernia repair. Hernia 2024; 28:1151-1159. [PMID: 38429399 DOI: 10.1007/s10029-024-02995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE The objective of this study is to evaluate the safety and long-term outcomes of GORE Synecor™ in ventral hernia repair (VHR). METHODS This retrospective, single-center case review analyzed outcomes in patients who underwent VHR with Synecor from May 2016 to December 2022. Primary outcomes were hernia recurrence and mesh infection rates. Secondary outcomes were 30-day morbidity, 30-day mortality, 30-day readmission, re-operation, surgical-site infection (SSI) and occurrence (SSO) rates, and occurrences requiring intervention (SSOI). RESULTS 278 patients were identified. Mean follow-up was 24.1 (0.2-87.1) months. Mean hernia defect size was 63.4 (± 77.2) cm2. Overall hernia recurrence and mesh infection rates were 5.0% and 1.4% respectively. No mesh infections required full explantation. We report the following overall rates: 13.3% 30-day morbidity, 4.7% 30-day readmission, 2.9% re-operation, 7.2% SSI, 6.1% SSO, and 2.9% SSOI. 30-day morbidity was significantly higher in non-clean (42.1% vs 11.2%, p < 0.01), onlay (OL) mesh (37.0% vs preperitoneal (PP) 16.4%, p = 0.05 vs retrorectus (RR) 15.0%, p < 0.05 vs intraperitoneal (IP) 5.2%, p < 0.001), and open cases (23.5% vs 3.1% laparoscopic vs 4.4% robotic, p < 0.01). SSI rates were significantly higher in non-clean (31.6% vs 5.4%, p < 0.001), OL mesh (29.6% vs RR 11.3%, p < 0.05 vs PP 5.5%, p < 0.01 vs IP 0.0%, p < 0.001), and open cases (15.2% vs 0% laparoscopic vs 0% robotic, p < 0.05). CONCLUSION Long-term performance of a novel hybrid mesh in VHR demonstrates a low recurrence rate and favorable safety profile in various defect sizes and mesh placement locations.
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Affiliation(s)
- G J Spurzem
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr, La Jolla, CA, 92037, USA.
| | - R C Broderick
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr, La Jolla, CA, 92037, USA
| | - J Z Li
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr, La Jolla, CA, 92037, USA
| | - B J Sandler
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr, La Jolla, CA, 92037, USA
| | - S Horgan
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr, La Jolla, CA, 92037, USA
| | - G R Jacobsen
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, 9300 Campus Point Dr, La Jolla, CA, 92037, USA
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Khader R, Whitehead-Clarke T, Mudera V, Kureshi A. Assessment of mesh shrinkage using fibroblast-populated collagen matrices: a proof of concept for in vitro hernia mesh testing. Hernia 2024; 28:495-505. [PMID: 38180627 PMCID: PMC10997730 DOI: 10.1007/s10029-023-02941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This study uses free-floating contractile fibroblast-populated collagen matrices (FPCMs) to test the shrinkage of different hernia mesh products. We hope to present this model as a proof of concept for the development of in vitro hernia mesh testing-a novel technology with interesting potential. METHODS FPCMs were formed by seeding Human Dermal Fibroblasts into collagen gels. FPCMs were seeded with three different cell densities and cast at a volume of 500 μl into 24-well plates. Five different mesh products were embedded within the collagen constructs. Gels were left to float freely within culture media and contract over 5 days. Photographs were taken daily and the area of the collagen gel and mesh were measured. Media samples were taken at days 2 and 4 for the purposes of measuring MMP-9 release. After 5 days, dehydrated FPCMs were also examined under light and fluorescence microscopy to assess cell morphology. RESULTS Two mesh products-the mosquito net and large pore lightweight mesh were found to shrink notably more than others. This pattern persisted across all three cell densities. There were no appreciable differences observed in MMP-9 release between products. CONCLUSIONS This study has successfully demonstrated that commercial mesh products can be successfully integrated into free-floating contractile FPCMs. Not only this, but FPCMs are capable of applying a contractile force upon those mesh products-eliciting different levels of contraction between mesh products. Such findings demonstrate this technique as a useful proof of concept for future development of in vitro hernia mesh testing.
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Affiliation(s)
- R Khader
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
| | - T Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK.
| | - V Mudera
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
| | - A Kureshi
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
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Roth JS, Anthone GJ, Selzer DJ, Poulose BK, Pierce RA, Bittner JG, Hope WW, Dunn RM, Martindale RG, Goldblatt MI, Earle DB, Romanelli JR, Mancini GJ, Greenberg JA, Linn JG, Parra-Davila E, Sandler BJ, Deeken CR, Verbarg J, Salluzzo JL, Voeller GR. Prospective, multicenter study of P4HB (Phasix™) mesh for hernia repair in cohort at risk for complications: 3-Year follow-up. Ann Med Surg (Lond) 2021; 61:1-7. [PMID: 33363718 PMCID: PMC7750179 DOI: 10.1016/j.amsu.2020.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This study represents a prospective, multicenter, open-label study to assess the safety, performance, and outcomes of poly-4-hydroxybutyrate (P4HB, Phasix™) mesh for primary ventral, primary incisional, or multiply-recurrent hernia in subjects at risk for complications. This study reports 3-year clinical outcomes. MATERIALS AND METHODS P4HB mesh was implanted in 121 patients via retrorectus or onlay technique. Physical exam and/or quality of life surveys were completed at 1, 3, 6,12, 18, 24, and 36 months, with 5-year (60-month) follow-up ongoing. RESULTS A total of n = 121 patients were implanted with P4HB mesh (n = 75 (62%) female) with a mean age of 54.7 ± 12.0 years and mean BMI of 32.2 ± 4.5 kg/m2 (±standard deviation). Comorbidities included: obesity (78.5%), active smokers (23.1%), COPD (28.1%), diabetes mellitus (33.1%), immunosuppression (8.3%), coronary artery disease (21.5%), chronic corticosteroid use (5.0%), hypo-albuminemia (2.5%), advanced age (5.0%), and renal insufficiency (0.8%). Hernias were repaired via retrorectus (n = 45, 37.2% with myofascial release (MR) or n = 43, 35.5% without MR), onlay (n = 8, 6.6% with MR or n = 24, 19.8% without MR), or not reported (n = 1, 0.8%). 82 patients (67.8%) completed 36-month follow-up. 17 patients (17.9% ± 0.4%) experienced hernia recurrence at 3 years, with n = 9 in the retrorectus group and n = 8 in the onlay group. SSI (n = 11) occurred in 9.3% ± 0.03% of patients. CONCLUSIONS Long-term outcomes following ventral hernia repair with P4HB mesh demonstrate low recurrence rates at 3-year (36-month) postoperative time frame with no patients developing late mesh complications or requiring mesh removal. 5-year (60-month) follow-up is ongoing.
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Affiliation(s)
- John Scott Roth
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY, USA
| | - Gary J. Anthone
- Department of Surgery, Methodist Health System, Omaha, NE, USA
| | - Don J. Selzer
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin K. Poulose
- Center for Abdominal Core Health, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Richard A. Pierce
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James G. Bittner
- Department of Surgery, Saint Francis Hospital, Hartford, CT, USA
| | - William W. Hope
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Raymond M. Dunn
- Department of Surgery, University of Massachusetts Worcester, Worcester, MA, USA
| | | | - Matthew I. Goldblatt
- Department of Surgery, The Medical College of Wisconsin, Inc., Milwaukee, WI, USA
| | - David B. Earle
- Department of Surgery, New England Hernia Center, Lowell, MA, USA
| | - John R. Romanelli
- Department of Surgery, Baystate Medical Center, Springfield, MA, USA
| | - Gregory J. Mancini
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jacob A. Greenberg
- Department of Surgery, Board of Regents of the University of Wisconsin System, Madison, WI, USA
| | - John G. Linn
- Department of Surgery, North Shore University Health System, Evanston, IL, USA
| | | | - Bryan J. Sandler
- Department of Surgery, The Regents of the University of California, San Diego, CA, USA
| | | | | | | | - Guy R. Voeller
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
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