Reducing Hernia Recurrence to Free Up Surgical Capacity: A Value Based Procurement Approach with Second-Generation Mesh

¹ There are almost 100,000 hernia repairs performed annually in England. For every four hernias, three are repaired with mesh. Recurrent hernia surgery remains a large burden to the NHS.

Patients undergoing Complex Abdominal Wall Reconstruction (CAWR) historically face a high risk of surgical site infections combined with a significant risk of recurrence.

Clinicians classify these patients into three grades based on the modified Ventral Hernia Working Group (mVHWG) system, with Grade 3 indicating the most complex cases.

A significant unmet clinical need exists for patients who are at high risk of infection and related complications.

Despite the widespread use of Porcine Acellular Dermal Matrix (PADM) and Bovine Acellular Dermal Matrix (BADM) biologic meshes in these surgeries, there remains a high incidence of subsequent recurrent incisional hernias.

This is due to the diminishing strength of the biologic material over time, often requiring patients to have additional surgeries.

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To support the NHS in implementing innovative products into the patient pathway utilising Value Based Procurement (VBP), by replacing traditional biologic meshes with second-generation mesh in Grade 3 CAWR.

The pilot aimed to deliver:

• Enhanced patient pathways by introducing advanced mesh solutions expected to reduce the need for repeat hernia surgeries, leading to fewer complications and improved long-term outcomes.
• Improved system productivity and efficiency by reducing total care pathway costs, optimising clinician time, and increasing surgical throughput. ² These improvements will support greater capacity and align with national programmes such as Get It Right First Time (GIRFT) Further Faster (FF20).
• Socio-economic benefits by improving health and reducing pain, enabling individuals to participate more fully in work, social, and recreational activities. Lower recurrence rates will help alleviate patient anxiety and improve overall quality of life, contributing to a healthier and more economically active population.
• Financial savings through the adoption of innovative mesh technologies that offer a more cost-effective alternative to biologic meshes derived from decellularised human or animal tissue.

In this case study, NHS Supply Chain and TELA Bio have partnered with Mr Paul Wilson, Consultant in General, Laparoscopic and Abdominal Wall Reconstruction Surgery, at University Hospitals of Morecambe Bay.

The trust conducted an audit of patients who underwent hernia repairs using Biological Acellular Dermal Matrix (BADM). In a cohort of 105 patients treated between 2015 and 2019, the three-year recurrence rate was 80%.

³ The supplier presented the published clinical data for their second-generation mesh OviTex to the trust clinical network, including consultant surgeons and a multi-disciplinary team (MDT) of clinicians.

The team decided to trial second-generation mesh in Grade 3 CAWR based on these inputs.

OviTex combines sheep stomach tissue into a reinforced matrix, designed to address long-term complications associated with first-generation biologic meshes.

Nine clinical studies utilising second-generation mesh in open hernia repair show low hernia recurrence rates (0–8.7%) and no mesh-related complications.

Even when infections occur, clinicians usually don’t need to remove the mesh, making this product a more effective option for reducing hernia recurrence and managing infections.

Researchers have published additional clinical studies evaluating the use of OviTex in Complex Abdominal Wall Reconstruction (CAWR) internationally, including data from the UK, USA, and the Netherlands. You can access these studies online by searching for ‘OviTex CAWR clinical studies’ or by referencing authors such as Wilson, Nazarei, Timmer, Parker, and Ankney.

• One patient in 120 required revisionary surgery within one year of treatment to August 2025.
• Patients reported high levels of satisfaction.
• Significantly improved surgical handling of second-generation mesh compared to BADM.

Pathways created:

The clinical team developed two pathways to compare the productivity and efficiency benefits of the previous and current practices:

• Pathway one – open CAWR grade 3 using non-reinforced BADM 3.0 mm biological mesh.
• Pathway two – single-stage definitive repair using second-generation mesh-reinforced tissue matrix in open CAWR grade 3.

Pathway two, which utilised second-generation mesh, has now become the standard of care for open CAWR in grade 3 cases.

The following costs were calculated for the two pathways at University Hospitals Morecombe Bay NHS Foundation Trust:

• Pathway one cost – BADM: £32,057 per patient
• Pathway two cost – OviTex: £15,619 per patient.

Productivity and Efficiency Saving: £16,439 per patient by reducing the need for additional surgeries and associated procedures.

As of August 2025, 120 patients have benefitted from the use of pathway two, contributing to measurable improvements in clinical outcomes and cost efficiency.

If pathway one was utilised, these 120 patients would have seen a historic recurrence rate of 80%.

The recurrence rate for pathway two is 0.08% in year one; the three-year recurrence rate is zero as of August 2025.

Therefore, the trust has avoided recurrent surgery in 79.92% of the 120 patients, based on previous revisionary surgery rates under pathway one based on three-year recurrence.

⁴ This has led to significantly improved clinical and patient outcomes, as well as increased productivity and efficiency, freeing up resources to focus on elective waiting list reduction aligned with both the Elective Recovery Programme and GIRFT (FF20).

Reduction In Bed Days / Length of Stay (LOS):

The procedure can be performed as an open CAWR or a minimally invasive laparoscopic approach.

Of the 120 patients within the study:

• 88 Patients received open CAWR surgery.
• 32 Patients received a minimally invasive/laparoscopic approach.

Where the patient was treated with a minimally invasive procedure, the median LOS was 0 days.
Where the patient is treated with open CAWR, the median LOS was 6 days.

Pathway one median total bed days = 12
Pathway two median total bed days = 6.

Pathway two delivered a reduction of 6 bed days per patient for the 88 patients treated with open CAWR.
⁵ At a cost of £345 per bed day (NHS National Cost Collection).

• Reducing revisionary operations for hernia recurrence
• Reduce the prevalence of postoperative complications
• Increased patient well-being
• Potential mesh acquisition saving
• Enhanced socio-economic contribution/participation
• Sharing of best practices nationally, focused on the reduction in variation of surgical practice and improved clinical outcomes
• Centralisation of complex cases to tertiary centres
• Assist in the NHS Recovery Plan with increased productivity/capacity
• Support the GIRFT FF20 Programme.

The adoption of second-generation mesh use in open CAWR procedures at this trust has improved clinical outcomes and patient well-being. The pathway optimisation has also provided significant productivity and efficiency savings.

This pilot serves as an example of best practice in pathway optimisation; we encourage other NHS trusts to explore its findings. By adopting similar approaches, trusts can achieve measurable improvements in outcomes and resource utilisation.

Connect with our Care Pathway Team to learn more or explore how your trust could adapt this pathway, and receive tailored support and guidance.

The Care Pathway Team Offer:

• Pathway design and implementation guidance
• Productivity and Efficiency Calculators to model return on investment
• Access to clinical case studies and video testimonials
• A trust specific tailored walkthrough of the second-generation mesh model.

Complete this short form and your regional Care Pathway team will contact you to guide you through current VBP opportunities, including this second-generation mesh for grade 3 CAWR solutions.

Enquire Now About Second-Generation Mesh

Complete our two minute enquiry form and your regional Care Pathway Specialist or Clinical Care Pathway Manager will respond with further details.