How Prevalent Is Biologic and Biosynthetic Mesh for Ventral Hernia Repair?

Mullens CL, Schoel L, McGee MF, et al. Use of Biologic and Biosynthetic Mesh for Ventral Hernia Repair in Current Practice. JAMA Surg. 2024; in press.

Alverdy JC. Misapplication of Biologic Mesh in Clean-Site Elective Ventral Hernia Repair. JAMA Surg. 2024; in press.

Biosynthetic mesh is recommended for ventral hernia repair in patients with contaminated operative fields and others who are at increased risk for mesh infection. There are insufficient data to document the frequency of biosynthetic mesh use in patients who are not at increased risk for mesh infection.

The authors used a statewide clinical registry to identify adult patients who underwent ventral hernia repair during a 2-year interval (n = 10,838). Mesh repair of ventral hernia was used in 4,619 patients; biologic mesh was used in 1,174.

Elective ventral hernia repair with biosynthetic mesh in non-contaminated fields was documented in 1,023 patients; a significant proportion of these procedures were performed laparoscopically or with robotic assistance.

Larger hernia defects were also associated with increased use of biosynthetic mesh. The authors concluded that nearly 90% of repairs using biosynthetic mesh were performed electively in clean operative fields. An opportunity to use focused surgeon education to reduce use of biosynthetic mesh, improve patient outcomes, and reduce costs likely exists.

In the editorial that accompanied the article, Alverdy hypothesized that surgeons’ concern over the extensive damage caused by mesh infection was a likely cause of misapplication of biologic mesh in clean-site ventral hernia repairs.