Less pain and foreign body sensation after incisional hernia repair with partially absorbable mesh than with non-absorbable mesh: a retrospective sequential cohort study

To compare postoperative morbimortality and pain assessment in incisional hernia (IH) repair with partially absorbable or non-absorbable mesh types.

A monocentric retrospective two-arm comparative study between non-absorbable polyester (PET) (n = 108) and partially absorbable Poly-L-Lactic based (PLLA)- polypropylene (PP) mesh (n = 47) consecutive placement in IH repair. Its primary objective was postoperative morbimortality in patients with grade-II Clavien-Dindo Classification or higher during the first 90-day postoperative period. Secondary objectives were early hernia recurrences, type and rate of complications, chronic pain and long-term quality-of-life assessment using the Patient Reported Outcomes Measures questionnaire.

Both groups were comparable in terms of (i) Demographic characteristics (age 60 ± 12 (p = 0.19); Male (43.9%, p = 0.38), BMI 28.9 ± 4.7 kg/m² (p = 0.99)); (ii) Midline IH localization (76.8%, p = 0.65), Ventral Hernia Working Group (VHWG) grade-I (34.2%, p = 0.73) and grade-II (63.8%, p = 0.73); (iii) Surgical technique: mostly laparotomy (98.1%, p = 0.25) and retrorectus mesh placement (89%, p = 0.54). More Transversus Abdominis Release was observed in the PLLA/PP group (38.3% vs. 19.4% p = 0.04). Postoperative morbimortality was comparable between PLLA/PP and PET groups (10.6%vs13%;p = 0.7), without significant differences in SSO rates (14.9%vs16.7%;p = 0.8) and early recurrences (2%vs0%;p = 0.13). Lower foreign body sensation was observed in the PLLA/PP group (4.8%) compared to the PET group (20.3%, p = 0.024). In the prediction pain model, risk of chronic severe pain was higher in the PET group (21.6% vs. 3.9%, p = 0.023).

PLLA/PP and PET mesh types have comparable safety. The predicted global risk of postoperative chronic pain was around 30%. However, the benefits of the PLLA/PP mesh could be correlated to its semi-absorbable nature.