Is the type of biomesh relevant in the prevention of recurrence following abdominal wall reconstruction? A randomized controlled trial

Abstract

Background: Complex abdominal wall reconstruction technique remains controversial. The use of biologic mesh products is also debated in active infection, sepsis prophylaxis and high-risk patients. Differences in biologic mesh technology and cost remain significant. We aimed to compare the efficacy of 2 commonly used biologic meshes in regards to hernia recurrence at 1 year. Methods: This study was a parallel, dual-arm, double-blind randomized controlled trial involving adult patients undergoing complex abdominal wall reconstruction with a biologic mesh at a quaternary care institution (2017–2020). Patients were randomly assigned to receive Permacol (cross-linked) compared with Strattice (not cross-linked). The main outcome measure was hernia recurrence at 1 or more years following the index repair. Results: We included 94 patients randomized to undergo reconstruction with 1 of 2 commonly used biologic mesh products (mean age 59.4 yr, standard deviation [SD] 9.9; 51% female; body mass index 32.9, SD 6.8). We found no significant differences between the groups (patient comorbidities, hernia recurrence risk factors, hernia size or infection profiles). Hernia recurrence rates (15%) were similar between groups (median 783 days of follow up, interquartile range 119). We found there was significantly less of a need for a component separation technique in the Strattice group (69% v. 87%). All other secondary outcome measures were equivalent between study arms. Multivariate analysis identified hepatic transplantation (odds ratio [OR] 1.94, 95% confidence intervals [CI] 0.33–4.41), active abdominal wall infection (OR 2.01, 95% CI 0.50–7.01), and more than 1 previous hernia repair (OR 2.68, 95% CI 0.41–5.99) as risk factors for subsequent hernia recurrence; however, there was no difference in recurrence factors between patient study groups. Conclusion: Given similar clinical performance between the 2 most commonly used biologic mesh products, the most cost effective mesh should be used in cost-conscious health care systems.