Versatility of Poly-4-hydroxybutyrate (Phasix™) mesh in abdominal wall surgery

Background – Poly-4-hydroxybutyrate (P4HB) is a naturally occurring polymer derived from transgenic E. coli bacteria with the longest degradation rate when compared to other available products. This polymer has been manufactured as a biosynthetic mesh to be used as reinforcement when repairing a variety of abdominal wall defects. Objective – We aim to describe our center initial experience with this mesh and discuss the possible indications that may benefit from the use of P4HB mesh. Methods – This is a descriptive retrospective study of patients who underwent abdominal wall repair with a P4HB mesh from October 2018 to December 2020 in a single, large volume, academic center. Results – A total of 51 patients (mean age 54.4 years, range 12–89) underwent abdominal wall reconstruction with a P4HB mesh between October 2018 and December 2020. The mean BMI was 30.5 (range 17.2–50.6). Twenty-three (45%) patients had a prior hernia repair at the site. We grouped patients into six different indications for the use of P4HB mesh in our cohort: clean-contaminated, contaminated or infected field (57%), patient refusal for permanent meshes (14%), those with high risk for post-operative infection (12%), visceral protection of second mesh (10%), recurrence with related chronic pain from mesh (6%), and children (2%). Median follow-up was 105 days (range 8–648). Two patients had hernia recurrence (4%) and 8 (16%) patients developed seroma. Conclusion – P4HB mesh is a safe and a viable alternative for complex hernias and high-risk patients with a low complication rate in the short-term.