Khan Salman, Hornick Margaret M, Voytik Malia, Broach Robyn B, Kovach Stephen J, Fischer John P
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA.
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA.
Surgery. 2025 Oct;186:109579. doi: 10.1016/j.surg.2025.109579. Epub 2025 Jul 19.
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.
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.
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/m (28.4-39.1 kg/m), 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 cm vs 141 cm, 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).
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.
生物合成补片与合成补片在腹疝修补术中的相对疗效仍是一个不断探索的领域。本研究旨在评估在清洁伤口中使用聚4-羟基丁酸生物合成补片（Phasix）或未涂层聚丙烯合成补片（Marlex）进行腹直肌后鞘腹疝修补术后的长期疗效。
本单中心回顾性队列研究纳入了2015年至2021年间在清洁伤口中使用生物合成或合成补片进行腹直肌后鞘腹疝修补术的患者，随访至疝复发或3年。使用包含年龄、体重指数、腹横肌松解和美国麻醉医师协会分级的马氏距离进行最佳完全匹配。
共纳入160例患者（49例使用合成补片，111例使用生物合成补片），中位年龄和体重指数分别为62岁（四分位间距，52.8 - 72.0岁）和33.7 kg/m²（28.4 - 39.1 kg/m²）。匹配后，两组间的基线特征、合并症和腹横肌松解使用率具有可比性；然而，生物合成补片组的平均缺损尺寸更大（220 cm²对141 cm²，P = 0.010）。生物合成补片组和合成补片组3年时的疝复发率无显著差异（分别为3.3%和7.0%；对数秩检验P = 0.4）。同样，手术部位感染（27%对37%，P = 0.3）、再入院率（17%对21%，P = 0.6）、需要进行手术干预的手术部位事件（11%对14%，P = 0.7）或全因再次手术率（17%对18%，P = 0.9）均无显著差异。
在这项匹配队列研究中，聚4-羟基丁酸和未涂层聚丙烯合成补片在清洁伤口的腹直肌后鞘腹疝修补术中显示出相当的长期疗效。
