Biologic Mesh in Surgery: A Comprehensive Review and Meta‐Analysis of Selected Outcomes in 51 Studies and 6079 Patients

Abstract

Background In recent decades, biologic mesh (BM) has become an important adjunct to surgical practice. Recent evidence‐based clinical applications of BM include but are not limited to: reconstruction of abdominal wall defects; breast reconstruction; face, head and neck surgery; periodontal surgery; other hernia repairs (diaphragmatic, hiatal/paraesophageal, inguinal and perineal); hand surgery; and shoulder arthroplasty. Prior systematic reviews of BM in complex abdominal wall hernia repair had several shortcomings that our comprehensive review seeks to address, including exclusion of laparoscopic repair, assessment of risk of bias, use of an acceptable meta‐analytic method and review of risk factors identified in multivariable regression analyses. Materials and methods We sought articles of BM for open ventral hernia repair reporting on early complications, late complications or recurrences and included minimum of 50. We used the quality in prognostic studies risk of bias assessment tool. Random effects meta‐analysis was applied. Results This comprehensive review selected 62 articles from 51 studies that included 6,079 patients. Meta‐analytic pooling found that early complications are present in about 50%, surgical site occurrences (SSOs) in 37%, surgical site infections (SSIs) in 18%, reoperation in 7%, readmission in 20% and mortality in 3%. Meta‐analytic estimates of late outcomes included overall complications (42%), SSOs (40%) and SSIs (22%). Specific SSOs included seroma (14%), hematoma (4%), abscess (10%), necrosis (5%), dehiscence (8%) and fistula formation (5%). Reoperation occurred in about 17%, mesh explantation in 9% and recurrence in 36%. Conclusion Estimates of nearly all outcomes from individual studies were highly heterogeneous and sensitivity analyses and meta‐regressions generally failed to explain this heterogeneity. Recurrence is the only outcome for which there are consistent findings for risk factors. Bridge placement of BM is associated with higher risk of recurrence. Prior hernia repair, history of reintervention and history of mesh removal were also risk factors for increased recurrence.

Ventral hernia repair in high-risk patients and contaminated fields using a single mesh: proportional meta-analysis

“…Sensitivity analyses performed to assess heterogeneity have shown that patient characteristics are not a source of this heterogeneity. Similar results are reported in the review by Samson et al [ 45 ]. This review included studies using biological implants in open VHR and analyzed reporting data on early complications, late complications, and recurrences.…”

Comparison of Medical Research Abstracts Written by Surgical Trainees and Senior Surgeons or Generated by Large Language Models

“…Once the chatbots were trained, we asked that it generate a scientific abstract based on the information provided. For each of the 10 abstracts, the chatbots were given the introduction and discussion of 3 relevant publications . Text limitations prevented us from giving the chatbots the entire article.…”

Update on surgical management of enteroatmospheric fistulae in intestinal failure patients

“…Early data suggests that non cross-linked biological meshes entail less fistula recurrence risk compared to cross-linked meshes [65,66 ▪ ]. Bridging placement of biological mesh poses a higher risk of hernia recurrence [67 ▪ ]. Nevertheless, avoidance of fistula recurrence should be prioritized over hernia development in these patients.…”