Cost-Utility Analysis of Biologic and Biosynthetic Mesh in Ventral Hernia Repair: When Are They Worth It?

Schneeberger, Steven; Phillips, Sharon; Huang, Li‐Ching; Pierce, Richard A.; Etemad, Shervin; Poulose, Benjamin K.

doi:10.1016/j.jamcollsurg.2018.10.009

Cited by 32 publications

(10 citation statements)

References 22 publications

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“…Schneeberger et al built up a cost-utility analysis model based on published studies, health care costs, utilization project data, and Americas Hernia Society Quality Collaborative data. This model showed that synthetic meshes are the best option in terms of cost-utility for a base case scenario with a five-year follow-up, but the use of biological meshes could be the best choice over the long term since the complication rate of synthetic meshes beyond five years increases up to the point that the higher initial cost is justified [58]. However, cost–utility analyses remain difficult since synthetic meshes are used in clean low-grade hernias, which leads to excellent clinical outcomes with a low cost, while biologic meshes are usually implanted in contaminated, higher-grade hernias or following hernia recurrence—cases that justify the high cost—leading to controversial outcomes that can be affected by the compromised preoperative scenario.…”

Section: Biological Scaffolds For Abdominal Wall Repairmentioning

confidence: 99%

Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application?

et al. 2019

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Millions of abdominal wall repair procedures are performed each year for primary and incisional hernias both in the European Union and in the United States with extremely high costs. Synthetic meshes approved for augmenting abdominal wall repair provide adequate mechanical support but have significant drawbacks (seroma formation, adhesion to viscera, stiffness of abdominal wall, and infection). Biologic scaffolds (i.e., derived from naturally occurring materials) represent an alternative to synthetic surgical meshes and are less sensitive to infection. Among biologic scaffolds, extracellular matrix scaffolds promote stem/progenitor cell recruitment in models of tissue remodeling and, in the specific application of abdominal wall repair, have enough mechanical strength to support the repair. However, many concerns remain about the use of these scaffolds in the clinic due to their higher cost of production compared with synthetic meshes, despite having the same recurrence rate. The present review aims to highlight the pros and cons of using biologic scaffolds as surgical devices for abdominal wall repair and present possible improvements to widen their use in clinical practice.

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Section: Biological Scaffolds For Abdominal Wall Repairmentioning

confidence: 99%

Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application?

et al. 2019

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“…FitzGerald JF et al [18] reported that the recurrence rate was signi cantly reduced when biological mesh used to reinforce the repair compared with used as a bridge. From the perspective of economics, Schneeberger et al [19] reported that with the decrease of biologic mesh cost and the increase of long-term complications of synthetic mesh, biologic mesh was more economical and effective than synthetic mesh.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Examination and Transabdominal Preperitoneal (TAPP) Approach with Biologic Mesh for Strangulated Direct Inguinal Hernia Accompanied by Small Intestinal Perforation

Xie¹,

Shujie²,

Fu³

et al. 2021

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Background A direct inguinal hernia is caused by a weakness or defect in the floor of the Hesselbach triangle. It is believed that direct hernias are less likely to strangulate than indirect hernias, because the neck of the direct hernia is wide enough to avoid strangulation. Approximately 8.6% of all incarcerated inguinal hernia contents can be returned to the abdominal cavity spontaneously after general anesthesia, and intestinal ischemia or necrosis was detected by laparoscopic examination in approximately 40.9% of cases. However, which surgical approach or mesh for an acutely incarcerated and strangulated groin hernia is still no consensus. We retrospectively enrolled 12 patients with incarcerated inguinal hernias accompanied by small intestinal perforation who underwent laparoscopic examination when the hernia content spontaneously returned into the abdominal cavity after induction of general anesthesia in our institution.Results 1 of the 12 patients had developed temporary seroma; the other 2 had early postoperative pain. No evidence of hernia recurrence, chronic pain, infection, scrotal swelling, paralyticileus, persistent seroma, mortality, or any other complications were found during the follow-up. At 1 year and most recent follow-up, all patients were satisfied with the treatment outcome.Conclusions It is a necessary to detect abdominal viscera when incarcerated inguinal hernia contents return to the abdominal cavity spontaneously after general anesthesia, and laparoscopic examination is an efficient method. Laparoscopic TAPP technique with biologic meshes is a feasible method to treat strangulated inguinal hernias accompanied by small intestinal perforation. To better understand whether TAPP or biologic mesh apply to strangulated inguinal hernia (especially enterectomy) and evaluate its wider application, this treatment will need to be tested in larger clinical trials.

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“…El tamaño de la prótesis requerida se logra en función del defecto herniario, y habitualmente son mallas planas convencionales. La utilización de algunas prótesis comercialmente disponibles, preformadas y recubiertas para la reparación intraperitoneal de la hernia umbilical, representa un coste superior y hasta la fecha no ha demostrado beneficio en la disminución de complicaciones y de recidivas herniarias 13 .…”

Section: Hernia Umbilical?unclassified

“…Por otra parte, las nuevas tecnologías en el desarrollo de materiales protésicos, como las mallas bioabsorbibles, prometen avances en la disminución de los efectos secundarios tardíos de las mallas sintéticas y constituyen un área de innovación futura para posibilitar una utilización masiva de los productos dado su impacto benéfico en los eventos adversos y la aparente efectividad en sus resultados 12,13 . La evidencia está en construcción.…”

Section: ¿Cuáles Son Las Expectativas Con Respecto a La Cirugía De La Hernia Umbilical?unclassified