Absorbable meshes:

What do the data tell us about their use in CAWR?

Marjolein Blussé van Oud-Alblas

Maasziekenhuis Pantein - NL

Mesh – Paris Dec 2021- pre-recorded

Introduction
 main goals of any hernia repair
 restore anatomy
 prevent recurrence
 prevent complications

 complex abdominal wall reconstruction

 patient & hernia characteristics
 choice of mesh
 permanent vs resorbable vs hybrid
Choice of mesh

 non-resorbable / permanent  resorbable

 synthetic
 synthetic
 biologic
 SSI?  safe in high risk setting
 (chronic) mesh infection?  recurrence up to 30% in 3y
 need for removal?  expensive
 biosynthetic
 same benefits as biologic
 hybrid  lower cost
 limited high level clinical Gore Bio-A
evidence Phasix Mesh
Tigr Matrix
 long term data?
Gore Synecore
TelaBio Ovitex
patient selection? recurrence?
Cook Medical Zenapro SSI?
Biosynthetic mesh
 absorbable synthetic polymer scaffold
 low inflammatory potential
 less recurrence

 over time replaced by fibrous tissue

 mid-term degradable (MTD)
• Gore Bio-A 6 months
 long-term degradable (LTD)
• Phasix Mesh 12-18 months
• Tigr Matrix 12-36 months

scaffold degradation vs collagen deposition

with biomechanical integrity and resistence
Pre-clinical data
overview of 4 pre-clinical studies
 Tigr Matrix - 2 separate copolymer fibers
 Gore Bio-A – copolymer
 Phasix - monofilament polymer produced by E.Coli

beware of bias – mostly industry driven trials

Plast. Reconstr. Surg. 142: 84S, 2018

Clinical data
 Complex Open Bioabsorbable Reconstruction of the Abdominal
Wall (COBRA) study
 prospective multicenter (non randomised)
 104 contaminated hernia’s >9 cm2
 single stage repair
 20% anterior & 48% posterior component separation
 BIO-A midline reinforcement
 90% retromuscular & 10% intraperitoneal
 84% completed 2y follow up
 17% midline recurrence – 18% SSI

Ann Surg. 2017 Jan; 265(I):205 - 211

Clinical data
 prospective multicenter USA data
 121 high risk patients hernia >10cm2
 Phasix LTD retromuscular
 myofascial release 37%
 Phasix onlay
 myofascial release 7%

 68% completed 3y follow up

 18% recurrence
 onlay 33%
 retrorectus 13%
 9% SSI
Annals of Medicine and Surgery 61 (2021) 1–7
Clinical data
 prospective, multicenter European data
 84 patients grade 3 hernia >10cm2
 Phasix LTD sublay = retromuscular
 58% CST

 26% SSO
 11% recurrence
 15% reoperation:
 43% recurrence
 21% mesh infection
 50% mesh explantation

Hernia. 2021 Jul online ahead of print

Clinical data
 2 independent prospectively registered series
 41 long-term degradable Phasix = LTD
 30 mid-term degradable Bio-A = MTD
 hernia >10cm2 or >20% loss of domain  botox
 one stage, single mesh or dual layer repair
 follow up LTD 35m vs MDT 11m

 overall SSI rate 46%

 persistent local infection; 10% mesh removal – all LTD
 overall salvage rate 60%; 30% LDT vs 100% MTD
 overall recurrence 10% at 20m follow up
 LTD 10% vs 10% MTD
Hernia. 2021 Jun 7:1-11
Conclusion – the ongoing debate:
which mesh in which patient?
 pt & hernia characteristics!
 prehabilitation and multidisciplinairy optimization

 moderate/high risk of SSI in comorbid CAWR patients

– regardless of which biosynthetic mesh is used

 in persistent infection LTD (Phasix) may need to be

removed - MTD (Bio-A) may be salvaged

Is single stage surgey in comorbid patients requiring CAWR

outdated?