Analysis of the Use of Poly-4-Hydroxybutyrate Mesh for Inguinal Hernia Repair: Our First 200 Cases

Abstract Introduction Inguinal hernia repair remains one the most common operation that general surgeons perform on an annual basis. Selection of a tissue based repair versus permanent or bio-rebsorbable biomaterials still remains an issue for both patients and surgeons when faced with options for inguinal hernia repair. Other studies have demonstrated the long-term strength profile associated with a resorbable mesh comprised of poly-4-hydroxybutyrate, in Ventral Hernia Repair. We however looked at the application of this type of bioprosthetic for use in inguinal hernia repair (IHR) Methods We retrospectively reviewed the continuous application of poly-4-hydroxybutyrate for open inguinal hernia repair at one center in the US. The study involves IHR with poly-4-hydroxybutyrate mesh in subjects across all types of open inguinal hernia to yield a larger overall, all-comers dataset at a minimum of 12-month postoperative timeframe follow-up. The trial includes a review comprised of 201 consecutive subjects. Poly-4-hydroxybutyrate plug and patch mesh was utilized in the groin for all primary and reccurent indirect, direct and femoral defects. Hernia complication rates including: recurrence rates, surgical site occurrences (SSO) requiring intervention, surgical site infection (SSI), seroma, wound dehiscence, skin necrosis, hematoma, were reviewed and will be reported. Results When the data for the subjects were reviewed it revealed that the distribution of the hernias were 24.4% direct, 68.1% indirect, 6.5% pantaloon, 1% femoral. 43% were left sided and 54% were right sided hernias; 90.55% were performed open and 9.45% were done MIS/Laparoscopically. Duration of follow-up was a minimum of 12 months. Overall complication rate was 2.99% inclusive of recurrence and when looked at independently the recurrence rate was 0.5% representing one laparoscopic recurrence. Conclusions Intermediate-term outcomes following inguinal hernia repair with poly-4-hydroxybutrate mesh in subjects with a minimum of one year of follow-up demonstrate low rates of recurrence and reasonable rates of SSO at the 12-month postoperative timeframe. Longer term follow-up will also be presented for 2 years and is also ongoing: Both 3 and 5-year (36,60-month) in the US at the same center and will be reported when results are available at a later date. Further study is needed to understand where and how this technology can be applied for IHR.