Abstract
ABSTRACT
Background
Immunosuppressed patients are more at risk of perioperative infections. In case of ventral hernia repair, the use of a long‐term absorbable mesh could potentially decrease the infectious risk in these patients. This study aimed to assess the short‐ and mid‐term outcomes of ventral hernia repair with long‐term absorbable mesh in immunosuppressed and non‐immunosuppressed patients compared with permanent mesh in non‐immunosuppressed patients.
Methods
A retrospective cohort study was conducted in two tertiary centers in France. Consecutive patients who underwent ventral hernia repair with a long‐term absorbable (poly‐4‐hydroxybutyrate, P4HB) mesh between 2017 and 2024 were included. Immunosuppression was defined as a decreased immunity level caused by a disease or medication. Outcomes of these patients were compared to non‐immunosuppressed patients who underwent ventral hernia repair with P4HB mesh and with synthetic mesh.
Results
A total of 465 patients were included: 27 in the immunosuppressed group with P4HB mesh, 232 non‐immunosuppressed patients with P4HB mesh, and 206 non‐immunosuppressed patients with synthetic mesh. Among patients with P4HB mesh, no differences in postoperative outcomes were found between the immunosuppressed and non‐immunosuppressed groups (mean follow‐up: 15 months, 95% CI 12–17). When comparing immunosuppressed patients with P4HB to non‐immunosuppressed patients with synthetic mesh, the morbidity rate was higher in immunosuppressed patients (12/27 = 44% vs. 38/206 = 18%,
p
= 0.002), while surgical site infection, mesh infection, or recurrence rates were similar (mean follow‐up: 19 months, 95% CI 16–23). Immunosuppression was not found as a predictor of surgical site infection (OR 5.0, 95% CI 0.7–10.0,
p
= 0.091).
Conclusions
Immunosuppressed patients with P4HB mesh had similar short‐ and mid‐term infectious complications to non‐immunosuppressed patients. Long‐term recurrence rates remain to be evaluated.