Mesh-related Outcomes of Biologic versus Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias: A Five to Ten Year Analysis of a Randomized Controlled Trial.

To determine the five- to ten-year safety and durability outcomes of biologic versus synthetic mesh in contaminated ventral hernia repair. Recent randomized controlled trials have demonstrated the safety and efficacy of synthetic mesh in clean-contaminated and contaminated ventral hernia repairs, but follow-up has typically been limited to two years. Concerns persist regarding long-term outcomes of synthetic mesh beyond this initial period. A minimum five-year follow-up analysis was conducted on 253 patients from our multicenter randomized controlled trial (NCT02451176). The primary outcome was cumulative long-term midline hernia recurrence risk. Secondary outcomes were long-term complications including mesh-related infection, excision and reoperation. Follow-up was achieved in 80.2% (n=203) of patients with a median follow-up of 5.4 years (IQR 2.1-6.8) and mean of 5.5 years (SD 2.7). Synthetic mesh was associated with a significant reduction in midline hernia recurrence risk (HR=0.46, 95% CI: 0.25-0.86, P=0.015). The five- to ten-year overall midline recurrence rate was 17.8%: 23.6% in the biologic group and 11.8% in the synthetic group, corresponding to an absolute risk reduction of 11.8% (95% CI: 2.1-21.4) with synthetic mesh. This advantage was primarily observed within the first two years with no significant difference in recurrence rates beyond two years. No new mesh infections or excisions occurred in either group beyond two years postoperatively. Three patients (1.2%) required intervention for ongoing wound-related issues. Synthetic mesh provides superior long-term recurrence outcomes without increased mesh-related complications in clean-contaminated and contaminated repairs when compared to biologic mesh.