Outcomes of Long‐Term Absorbable Mesh Use for Ventral Hernia Repair in Immunosuppressed Patients

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.