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Early wound morbidity and clinical outcomes associated with P4HB mesh compared to permanent synthetic mesh in umbilical and small to medium, routine ventral hernia repairs
Open accessAbstract
Background: Permanent synthetic meshes such as polypropylene (PP) have been utilized for hernia repair for decades, but concerns remain regarding potential long-term, mesh-related complications. A resorbable polymer such as poly-4-hydroxybutyrate (P4HB) represents an alternative with high initial strength, that gradually resorbs, leaving an abdominal wall that is at least as strong as it would be in its native state. We aimed to compare early wound morbidity and clinical outcomes associated with P4HB to traditional, permanent PP in umbilical and small to medium, routine ventral hernias using data from the Abdominal Core Health Quality Collaborative (ACHQC). Methods: Inclusion criteria for the umbilical cohort included: all Centers for Disease Control and Prevention (CDC) wound classes, all Ventral Hernia Working Group (VHWG) hernia grades, and hernia defects <3 cm. The small to medium, routine ventral hernia cohort was limited to CDC class I wounds, VHWG hernia grades I and II, and hernia defects <5 cm. The study group was comprised of P4HB meshes; the comparator group was an aggregate of PP meshes. Clinical outcomes were assessed at 30 days. Results: There was no significant difference in early wound morbidity, readmission, or reoperation between the P4HB and PP cohorts. A small number of patients experienced SSO, with ≤4% requiring procedural intervention. None of the patients (0% in all cases) experienced skin/soft tissue necrosis, infected seroma, infected hematoma, exposed/contaminated/infected mesh, enterocutaneous fistula, graft failure, or pain requiring intervention at 30-days. However, P4HB was associated with significantly greater operative time, length of stay, and use of myofascial release compared to PP (p < 0.05 in all cases). Conclusions: Short-term clinical outcomes associated with resorbable P4HB mesh are comparable to permanent synthetic PP mesh in umbilical and small to medium, routine ventral hernia repairs, despite significant differences in operative time and length of stay. Longer-term follow-up is needed to expand on the clinical relevance of these short-term findings.
Overview
CoChat Summary
TL;DR
In propensity-matched ACHQC data, resorbable P4HB mesh had early wound morbidity, readmission, and reoperation rates comparable to permanent polypropylene mesh in umbilical and small-to-medium routine ventral hernia repairs. P4HB was associated with significantly longer operative time, longer length of stay, and more myofascial release.
Key findings
- No significant differences were found between P4HB and PP for 30-day hernia recurrence, SSI, SSO, SSOPI, readmission, or reoperation in either cohort (p > 0.05 in all cases).
- Umbilical hernia cohort (n = 122 per group): P4HB had longer operative time (36.1% ≥2 h vs. 16.4% for PP; p < 0.001), longer length of stay (1.7 ± 3.8 vs. 0.4 ± 1.2 days; p < 0.001), and more myofascial release (30.3% vs. 11.5%; p < 0.001).
- Small-to-medium routine ventral hernia cohort (n = 235 per group): P4HB had longer operative time (47.7% ≥2 h vs. 32.8%; p = 0.022), longer length of stay (2.0 ± 4.9 vs. 1.0 ± 1.7 days; p = 0.020), and more myofascial release (45.1% vs. 31.9%; p = 0.003).
- SSO occurred in ≤6.5% of P4HB patients and ≤9.8% of PP patients across cohorts, with ≤4.0% requiring procedural intervention; 0% in all groups experienced hernia recurrence, infected seroma, infected hematoma, exposed/contaminated/infected mesh, enterocutaneous fistula, graft failure, or pain requiring intervention at 30 days.
Methods
- Retrospective analysis of prospectively collected Abdominal Core Health Quality Collaborative (ACHQC) data from January 2012 to September 2022.
- Umbilical cohort included all CDC wound classes, all VHWG grades, and defects <3 cm; small-to-medium routine ventral hernia cohort was limited to CDC class I wounds, VHWG grades I–II, and defects <5 cm. P4HB meshes were compared with an aggregate of permanent synthetic polypropylene meshes.
- Propensity score matching was used with variables including VHWG grade, hernia width, antiplatelet medications, age, operation approach, prior repairs, race, hypertension, concomitant procedure, ASA class, BMI, diabetes, and smoking. Outcomes were assessed at 30 days; Pearson’s chi-squared and Wilcoxon rank sum tests were used, with p < 0.05 considered significant.
Limitations
- Stated by the paper: retrospective design, short-term 30-day outcomes, potential selection bias from a voluntary database, and cost not evaluated.
- Evident from the text/tables: the proportion of evaluated patients and follow-up time differed significantly between groups (e.g., umbilical P4HB 75.4% evaluated vs. PP 86.9%; follow-up 27.7 ± 10.2 vs. 21.5 ± 10.3 days), which may affect outcome ascertainment.
- The paper also notes that “small to medium, routine ventral hernia” was not defined by a validated scale.
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Claims the paper makes
0 Valid · 0 Not valid · 16 Not checked · 48 Own results and interpretations
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“significantly longer length of stay (P4HB: 1.7 ± 3.8 days (median: 0.0; IQR: 0.0–1.0) vs. PP: 0.4 ± 1.2 days (median: 0.0; IQR: 0.0–0.0); p < 0.001)”
§ Early wound morbidity and clinical outcomes associated with P4HB mesh compared to permanent synthetic mesh in umbilical and small to medium, routine ventral hernia repairs > Results > Umbilical hernia cohort
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption not shown here.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“more procedures requiring myofascial release (P4HB: 30.3% vs. PP: 11.5%; p < 0.001)”
§ Early wound morbidity and clinical outcomes associated with P4HB mesh compared to permanent synthetic mesh in umbilical and small to medium, routine ventral hernia repairs > Results > Umbilical hernia cohort
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption not shown here.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, none of the patients in either cohort required reoperation during the follow-up period (n = 0 in all of the following categories: unrecognized bowel injury, major wound complication, postoperative bleeding, early recurrence, bowel obstruction, unrelated intraabdominal pathology, mesh excision, hernia at new ostomy site, or port site hernia).”
§ Early wound morbidity and clinical outcomes associated with P4HB mesh compared to permanent synthetic mesh in umbilical and small to medium, routine ventral hernia repairs > Results > Umbilical hernia cohort
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption not shown here.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“intraperitoneal: P4HB: 39.8% and PP: 58.4%”
§ Early wound morbidity and clinical outcomes associated with P4HB mesh compared to permanent synthetic mesh in umbilical and small to medium, routine ventral hernia repairs > Results > Umbilical hernia cohort
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption not shown here.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were no significant differences between P4HB and PP with regard to any of the short-term (30-day) postoperative complications evaluated in this study (Table 3), particularly hospital readmission, hernia recurrence, SSI, SSO, and SSOPI (p > 0.05 in all cases).”
§ Early wound morbidity and clinical outcomes associated with P4HB mesh compared to permanent synthetic mesh in umbilical and small to medium, routine ventral hernia repairs > Results > Umbilical hernia cohort
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption not shown here.
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Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| Readmission | Readmission | 3 (3.3%) | 3 (2.8%) | 7 (4.1%) | 6 (3.1%) |”
§ Early wound morbidity and clinical outcomes associated with P4HB mesh compared to permanent synthetic mesh in umbilical and small to medium, routine ventral hernia repairs > Results > Umbilical hernia cohort
Reported 4.1 · recomputed 4.022989
Citations
Cites
A comparison of suture repair with mesh repair for incisional hernia.
Luijendijk, R. W., Hop, W. C. J., van den Tol, M. P., de Lange, D. C. D., Braaksma, M. M. J., IJzermans, J. N. M., Boelhouwer, R. U., de Vries, B. C., Salu, M. K. M., Wereldsma, J. C. J., et al. (2000) · New England Journal of Medicine · doi:10.1056/nejm200008103430603 · Cited by 1,508
Burger, J. W. A., Luijendijk, R. W., Hop, W. C. J., Halm, J. A., Verdaasdonk, E. G. G., & Jeekel, J. (2004) · Annals of Surgery · doi:10.1097/01.sla.0000141193.08524.e7 · Cited by 1,340
Breuing, K. H., Butler, C. E., Ferzoco, S. J., Franz, M., Hultman, C. S., Kilbridge, J. F., Rosen, M. J., Silverman, R. P., & Vargo, D. J. (2010) · Surgery · doi:10.1016/j.surg.2010.01.008 · Cited by 1,037
Self-citationUnderlying reasons associated with hospital readmission following surgery in the United States
Merkow, R. P., Ju, M. H., Chung, J. W., Hall, B. L., Cohen, M. E., Williams, M. V., Tsai, T. C., Ko, C. Y., & Bilimoria, K. Y. (2015) · JAMA · doi:10.1001/jama.2014.18614 · Cited by 672
Medical applications of poly-4-hydroxybutyrate: A strong flexible absorbable biomaterial
Martin, D. P., & Williams, S. F. (2003) · Biochemical Engineering Journal · doi:10.1016/s1369-703x(03)00040-8 · Cited by 510
Long-term recurrence and complications associated with elective incisional hernia repair.
Kokotovic, D., Bisgaard, T., & Helgstrand, F. (2016) · JAMA · doi:10.1001/jama.2016.15217 · Cited by 391
Henriksen, N. A., Montgomery, A., Kaufmann, R., Berrevoet, F., East, B., Fischer, J., Hope, W., Klassen, D., Lorenz, R., Renard, Y., et al. (2020) · British Journal of Surgery · doi:10.1002/bjs.11489 · Cited by 368
Poulose, B. K., Roll, S., Murphy, J. W., Matthews, B. D., Todd Heniford, B., Voeller, G., Hope, W. W., Goldblatt, M. I., Adrales, G. L., & Rosen, M. J. (2016) · Hernia · doi:10.1007/s10029-016-1477-7 · Cited by 216
Self-citationNationwide prospective study of outcomes after elective incisional hernia repair
Helgstrand, F., Rosenberg, J., Kehlet, H., Jorgensen, L. N., & Bisgaard, T. (2013) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2012.10.013 · Cited by 197
Kaufmann, R., Halm, J. A., Eker, H. H., Klitsie, P. J., Nieuwenhuizen, J., van Geldere, D., Simons, M. P., van der Harst, E., van 't Riet, M., van der Holt, B., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30298-8 · Cited by 169
Cited by
Emerging materials and technologies for advancing bioresorbable surgical meshes
Heidari, B. S., Dodda, J. M., El-Khordagui, L. K., Focarete, M. L., Maróti, P., Tóth, L., Pacilio, S., El-Habashy, S. E., Boateng, J. S., Catanzano, O., et al. (2024) · Acta Biomaterialia · doi:10.1016/j.actbio.2024.06.012 · Cited by 60
Bueno‐Lledó, J., Porrero-Guerrero, B., Ferreira, F., Peña-Soria, M. J., Sanz-Sánchez, M., Roselló, A. M., Souto, R., López, R. R., & Pous‐Serrano, S. (2024) · Hernia · doi:10.1007/s10029-024-02981-6 · Cited by 13
Wieser, M., den Berg, R. V., & Romain, B. (2026) · Hernia · doi:10.1007/s10029-026-03699-3 · Cited by 3
Srivastava, A., Kummer, K. A., Troop, B. R., Gildehaus, A. J., Gunn, K., & Davis, G. (2025) · Hernia · doi:10.1007/s10029-025-03497-3 · Cited by 2
Gholami, R., Mohammadalipour, M., & Astaraki, H. (2026) · Advances in Polymer Technology · doi:10.1155/adv/3728039 · Cited by 1
Metadata
- Authors
- Deeken, C. R., Rosen, M. J., Poulose, B. K., Bradbury, K., Huang, L.-C., Ma, J., & Badhwar, A.
- Affiliations
- Cleveland Clinic (US)
- The Ohio State University Wexner Medical Center (US)
- Vanderbilt University Medical Center (US)
- Corresponding author
- Badhwar, Amit
- ORCID
- Venue
- Frontiers in Surgery
- Publisher
- Frontiers Media SA
- Published
- 2023-10-10
- Volume
- 10
- Pages
- 1280991-1280991
- ISSN
- 2296-875X (ISSN-L)
- PMC
- PMC10595000
- OpenAlex
- W4387500158
- Semantic Scholar
- 8c361c620d11ce5805991c203852ada07344d95f
- Cited by
- 7
- References
- 26
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 2
- FWCI
- 1.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Surgery (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- BD
- University of Warwick
- Topics
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Health Sciences › Medicine › Surgery › Surgical Sutures and Adhesives
- Health Sciences › Medicine › Surgery › Stoma care and complications
- Keywords
- resorbable mesh, polypropylene mesh, ventral hernia repair, umbilical hernia, wound morbidity, mesh complications, surgical site infection, reoperation, length of hospital stay, operative time, myofascial release, abdominal wall reconstruction
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