Positive Clinical Results Show Use Of Biologics For Abdominal Wall Reconstruction In Chemotherapy Patients
Surgical oncologist finds biologic mesh may reduce risk for surgical site infection and other complications in chemotherapy patients.
Choosing the right hernia mesh for any surgical case is an important decision for a surgeon. Between biologic mesh, synthetic mesh, differing materials and so on, it’s crucial that the material chosen is the best choice to promote proper healing and fend off the risk of infection.
While this decision is important for any surgical patient undergoing abdominal wall reconstruction, it is especially crucial for a chemotherapy patient. According to Dr. N. Joseph Espat M.D., M.S., FACS and professor of surgery at Boston University School of Medicine, and chief of surgical oncology and vice-chair of surgery at Roger Williams Medical Center, multiple studies report chemotherapy is a significant risk factor for surgical site infection and incisional hernia following abdominal wall tumor removal. Studies have shown that chemotherapy impairs wound healing due to increased inflammation and weaker collagen at the wound site. Due to these complications, synthetic mesh is often not a viable option for chemotherapy patients.
To find a solution for these patients, Dr. Espat studied and concluded favorable results of biologic materials for treating abdominal wall wounds complicated from chemotherapy. His findings show that biologic mesh, specifically Cook Medical’s Biodesign™ used in the study, is effective at treating high-risk patients with preoperative abdominal wall morbidity, gastrointestinal perforation and those patients receiving hyperthermic intraperitoneal chemotherapy or cytoreductive surgical procedures. In the study, the graft proved to reduce postoperative adhesions, reduce the risk of surgical site infection and eliminate enterotomies of fragile bowel after chemotherapy during subsequent surgeries.
As Dr. Mike Hiles, Vice President of Research and Lead Research at Cook Medical, explains, the difference in infection risk between a synthetic mesh and biologic mesh is in the long-term. Synthetic mesh is built from plastics and polymers. When implanted into the patient, tissue grows around it within months of surgery, but the mesh is always there, providing long-term strength for the repair. However, because the mesh is plastic and always present, it is possible for the body to treat the mesh as a foreign object. The mesh may harbor bacteria over time and result in a long-term infection.
“There is a short-term risk of infection that happens right after surgery that is possible with any graft,” Hiles explains. “Then there’s a long-term risk of infection where bacteria gets down into the pores of mesh and the mesh can become completely infected and it will have to be removed.
With a biologic mesh, Hiles continues, the material is made of harvested tissue from another animal—in the case of Biodesign used in Dr. Espat’s study, it’s made of pig intestine. The material promotes regenerative healing through a “remodeling process” stimulating the body to re-grow its own tissue.
According to the company, upon deployment, the biologic graft reinforces the abdominal wall and, over time, works with the patient’s body, signaling surrounding tissue to grow across the scaffold where the abdominal wall needs to be repaired. While every patient and surgery will be different, this process generally is done in 6 months or so, Hiles says. Through this remodeling process, the biologic mesh alleviates the risk of the body reacting to a “foreign” object, helping to relieve a long-term risk of infection.
Through Dr. Espat’s findings, it seems biologic mesh presents the ability to withstand aggressive chemotherapy treatments and the associated risk of infection, and it may be the answer for a safe repair alternative for chemotherapy patients.
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