Comparative Effectiveness Analysis of Resorbable Synthetic Onlay and Biologic Intraperitoneal Mesh for Abdominal Wall Reconstruction: A 2-Year Match-Paired Analysis.

BACKGROUND

Abdominal wall reconstruction persists as a challenging surgical issue with a multitude of management strategies available. The aim of this study was to examine the efficacy of resorbable synthetic mesh onlay plane against biologic mesh in the intraperitoneal plane.

METHODS

A single-center, two-surgeon, 5-year retrospective review (2014 to 2019) was performed examining subjects who underwent abdominal wall reconstruction in the onlay plane with resorbable synthetic mesh or in the intraperitoneal plane with biologic mesh. A matched paired analysis was conducted. Data examining demographic characteristics, intraoperative variables, postoperative outcomes, and costs were analyzed.

RESULTS

Eighty-eight subjects (44 per group) were identified (median follow-up, 24.5 months). The mean age was 57.7 years, with a mean body mass index of 30.4 kg/m2. The average defect size was 292 ± 237 cm2, with most wounds being clean-contaminated (48.9 percent) and 55 percent having failed prior repair. Resorbable synthetic mesh onlay subjects were significantly less likely (4.5 percent) to experience recurrence compared to biologic intraperitoneal mesh subjects (22.7 percent; p < 0.026). In addition, mesh onlay suffered fewer postoperative surgical-site occurrences (18.2 percent versus 40.9 percent; p < 0.019) and required fewer procedural interventions (11.4 percent versus 36.4 percent; p < 0.011), and was also associated with significantly lower total costs ($16,658 ± $14,930) compared to biologic intraperitoneal mesh ($27,645 ± $16,864; p < 0.001).

CONCLUSIONS

Abdominal wall reconstruction remains an evolving field, with various techniques available for treatment. When faced with hernia repair, resorbable synthetic mesh in the onlay plane may be preferable to biologic mesh placed in the intraperitoneal plane because of lower long-term recurrence rates, surgical-site complications, and costs.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.