A Prospective Trial of a Bio-absorbable Mesh in Challenging Laparoscopic Ventral or Incisional Hernia Repair

Subjects at high risk are defined as having 1 or more of the following co-morbid conditions:
body mass index (BMI) between 30-40 kg/m2, inclusive, active smokers, chronic obstructive
pulmonary disease (COPD), diabetes, immunosuppression, coronary artery disease, chronic
corticosteroid use, low pre-operative serum albumin, advanced age, or renal insufficiency.

Inclusion Criteria:

- Subject must be 18 years of age or older

- Subject must be willing to give written informed consent

- Subject must be diagnosed with ventral or abdominal incisional hernia

- Subject must be willing to undergo laparoscopic hernia repair using intraabdominal
placement (with or without Component Separation Technique (CST))

- Surgeon must be able to fully close the hernia defect. Defect closure is defined as
complete reapproximation of fascial edges, leaving no gap. Since the safety and
effectiveness of Phasix™ ST Mesh in bridging repairs has not been evaluated or
established, the defect should be closed prior to mesh use.

- Subject is expected to meet the criteria for a Class I wound

- Subjects must have 1 or more of the following pre-study conditions:

1. Body Mass Index (BMI) between 30-40 kg/m2, inclusive

2. Active smoker (including if attempts to quit smoking within two weeks of surgery
have failed and the patient is still an active smoker at the time of surgery)

3. COPD presence on patient self-report

4. Diabetes mellitus (if yes, diagnosis to be confirmed via medical records or
laboratory results according to 2014 Joslin Clinical Guideline for Adults with
Diabetes)(Appendix 5)

5. Immunosuppression

6. Coronary Artery Disease

7. Chronic corticosteroid use: greater than 6 months systemic use

8. Serum albumin less than 3.4 g/dL

9. Advanced age: 75 years or older

10. Renal insufficiency, defined as serum creatinine concentration ≥2.5 mg/dL

Exclusion Criteria:

- Subject has had 4 or more previous hernia repairs (of the index hernia)

- Subject's hernia is > 350 cm2

- Complete removal of existing mesh from a prior hernia repair (in the same affected
area) is not possible

- Subject has intact permanent mesh adjacent to the current hernia to be repaired

- Preperitoneal placement of mesh

- The subject is known to have a collagen disorder

- The subject has peritonitis

- The subject is on or suspected to be placed on chemotherapy medications during any
part of the study

- The subject's Body Mass Index (BMI) is > 40 kg/m2

- The subject has cirrhosis of the liver and/or ascites

- Subject is American Society of Anesthesiology Class 4 or 5

- Subject has a life expectancy of less than 2 years at the time of enrollment

- Subject has any condition that, in the opinion of the Investigator, would preclude the
use of the study device, or preclude the subject from completing the follow-up
requirements

- Subject has a surgical wound classified as Class II (Clean-Contaminated), Class III
(Contaminated) or Class IV (Dirty-Contaminated) as defined by the CDC

- Subject has an active or latent systemic infection

- Patient has a contraindication to placement of mesh

- Subject requires surgical bridge repair as the sole repair

- Subject is pregnant or has plans to become pregnant during the study period

- Subject has enrolled in another interventional clinical study within the last 30 days

- Subject is part of the site personnel directly involved with this study

- Subject has a known allergy to the test device or component materials (patients with
known allergies to tetracycline hydrochloride or kanamycin sulfate should be avoided).