Absorbable mesh for ventral hernia repair in immunosuppressed patients: similar infection rates in a small cohort

Design

Retrospective cohort, two tertiary centres in France, 2017 to 2024

Population

465 ventral hernia repairs: 27 immunosuppressed with absorbable mesh, 232 non-immunosuppressed with absorbable mesh, 206 non-immunosuppressed with synthetic mesh

Primary outcome

Short- and mid-term postoperative outcomes including surgical site and mesh infection and recurrence

Effect

Morbidity 44% (12 of 27) vs 18% (38 of 206); surgical site infection, mesh infection and recurrence similar

This French two-centre retrospective study included 465 ventral hernia repairs done with a long-term absorbable poly-4-hydroxybutyrate mesh or a synthetic mesh between 2017 and 2024. Only 27 patients were immunosuppressed and received the absorbable mesh.

Among patients given the absorbable mesh, outcomes did not differ between immunosuppressed and non-immunosuppressed groups (mean follow-up 15 months). Compared with non-immunosuppressed patients given synthetic mesh, the immunosuppressed group had higher overall morbidity (12 of 27, 44%, vs 38 of 206, 18%), while surgical site infection, mesh infection and recurrence were similar. Immunosuppression was not a significant predictor of surgical site infection (OR 5.0, 95% CI 0.7 to 10.0).

With 27 patients and a mean follow-up of 15 to 19 months, this cannot show that absorbable mesh protects against infection or that recurrence will stay low, as the authors note.

• Consider the absorbable-mesh option in immunosuppressed patients, but discuss that the evidence is a small retrospective series.
• Expect higher overall morbidity in immunosuppressed patients than in non-immunosuppressed patients with synthetic mesh.
• Plan long-term follow-up; recurrence beyond about 19 months is not known.
• Optimise modifiable risks, including steroid dose, glycaemia and smoking, before elective repair.

Why it matters

It asks whether a mesh that disappears carries less infection risk in the patients most worried about it.

Don't overread it

Twenty-seven patients and no comparison against synthetic mesh in the same immunosuppressed group; it does not show absorbable mesh is safer.

The statistics, in plain English

The odds ratio for infection (5.0, 95% CI 0.7 to 10.0) crosses 1.0 and is too imprecise to say either that immunosuppression raises infection risk or that it does not. The study simply had too few immunosuppressed patients to tell.

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