Outcomes of Poly-4-hydroxybutyrate Mesh in Ventral Hernia Repair: A Systematic Review and Pooled Analysis.

Autor:	Mellia JA; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa., Othman S; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa., Naga HI; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa., Messa CA 4th; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa., Elfanagely O; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa., Byrnes YM; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa., Basta MN; Department of Plastic and Reconstructive Surgery, Brown University, Providence, R.I., Fischer JP; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery. Global open [Plast Reconstr Surg Glob Open] 2020 Dec 16; Vol. 8 (12), pp. e3158. Date of Electronic Publication: 2020 Dec 16 (Print Publication: 2020).
DOI:	10.1097/GOX.0000000000003158
Abstrakt:	Within the past decade, poly-4-hydroxybutyrate (P4HB) biosynthetic mesh has been introduced as a potential alternative to traditional biologic and synthetic mesh in ventral hernia repair (VHR). The aim of this study was to systematically assess clinical outcomes with the P4HB in VHR. Methods: A literature search identified all articles published in 2000 involving the use of P4HB in VHR. Descriptive statistics were used to synthesize collective data points, including postoperative outcomes. A pooled analysis of postoperative outcomes was performed using chi-square test and Fisher exact test. Results: Across 7 studies, the P4HB was used in 453 patients. The mean rate of surgical site infection (SSI) was 6.8% (31/453), reoperation 10.7% (30/281), and recurrence 9.1% (41/453). At an average follow-up of 26.8 months, the incidence of recurrence was 10.4% (28/270). Onlay was significantly associated with increased recurrence (14.2% versus 4.4%, P = 0.001). Among sublay placements, there was no difference in recurrence in clean (Center for Disease Control [CDC] 1) or contaminated (CDC >1) wounds (2.7% versus 6.1%, P = 0.585), but contaminated wounds were associated with increased SSI (2.7% versus 15.2%, P = 0.028). Ventral Hernia Working Group grade 2 and 3 did not have different incidences of recurrence (8.0% versus 5.1%, P = 0.526) nor SSI (5.1% versus 14.6%, P = 0.265). Conclusions: Overall, clinical outcomes of the P4HB mesh in VHR are acceptable. The P4HB mesh serves as a reliable alternative to traditional synthetic and biologic mesh across a range of defect characteristics and patient health conditions. Further research is needed to better understand the conditions in which it may provide a clinical benefit over traditional mesh types. (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu