Outcomes of biologic versus synthetic mesh in CDC class 3 and 4 open abdominal wall reconstruction

M, Katzen; Ayuso, Sullivan A.; Sacco, Jana; Ku, Dau; Scarola, Gregory T.; Kercher, Kent W.; Colavita, Paul D.; Augenstein, Vedra A.; Heniford, B. Todd

doi:10.1007/s00464-022-09486-2

Cited by 12 publications

(11 citation statements)

References 53 publications

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“…Previous studies have suggested that using a biological mesh can improve bacterial clearance [23, 24]. In addition, Baumann et al suggested that biological meshes in the host remodel tissue through neocellularization, neovascularization, and collagen deposition, instead of scar tissue and encapsulation [24].…”

Section: Discussionmentioning

confidence: 99%

Synthetic Versus Biological Mesh in Ventral Hernia Repair and Abdominal Wall Reconstruction: A Systematic Review and Recommendations from Evidence‐Based Medicine

Shi,

Wang,

Dong

et al. 2023

World j. surg.

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Aim To compare the efficacy and safety of synthetic and biological meshes in ventral hernia repair (VHR) and abdominal wall reconstruction (AWR). Methods We screened all clinical trials that reported the application of synthetic and biological meshes in VHR and AWR using Medline, Web of Science, and Embase (Ovid). Only comparative studies with similar baselines such as age, sex, body mass index, degree of wound contamination, and hernia defects between the intervention and control groups were included. Effect sizes with 95% confidence were pooled using a random-or fixed-effects model based on the size of heterogeneity. A sensitivity analysis was performed to test the stability of the results. Results Ten studies with 1305 participants were included. Biological meshes were associated with significantly higher recurrence rate (OR, 2.09; 95% CI 1.42-3.08; I 2 = 50%), surgical site infection (OR, 1.47; 95% CI 1.10-1.97; I 2 = 30%), higher re-admission rate (OR, 1.51; 95% CI 1.05-2.17; I 2 = 50%), and longer length of hospital stay (SMD, 0.37; 95% CI 0.10-0.65; I 2 = 72%). Similar surgical site occurrence, re-operation rate, and mesh explantation rate were observed among biological and synthetic meshes. Biological meshes have no difference in recurrence rate as compared to synthetic meshes, between the clean-contaminated, and contamination-infected fields (OR, 1.41; 95% CI 0.41-4.87 vs 3.00; 95% CI 1.07-8.46; P = 0.36). Conclusion Synthetic meshes are a safe alternative to biological meshes for VHR and AWR. Considering the high cost of biological meshes, synthetic meshes are more appropriate for the VHR and AWR.

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Section: Discussionmentioning

confidence: 99%

Synthetic Versus Biological Mesh in Ventral Hernia Repair and Abdominal Wall Reconstruction: A Systematic Review and Recommendations from Evidence‐Based Medicine

Shi,

Wang,

Dong

et al. 2023

World j. surg.

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“…Hernia from 25 to 99%, but complication rates in our study ranged from 0 to 26%, including minor events [20]. Stabilized tissue appears to minimize complications such as seroma or hematoma formation.…”

Section: Discussionmentioning

confidence: 60%

Three-year follow-up of the grip concept: an open, prospective, observational registry study on biomechanically calculated abdominal wall repair for complex incisional hernias

Nessel,

Löffler,

Rinn

et al. 2024

Hernia

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Purpose We studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial. Methods From July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva’s maneuver. Results Larger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years. Conclusions Biomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.

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“…Of these, 9 were included, covering 1252 patients with an average follow-up time of 24 months, including randomized clinical trials and retrospective observational cohorts that enrolled patients with complex hernias in a contaminated environment classi ed as CDC class II, III, or IV undergoing abdominal wall reconstruction, evaluating at least one of the outcomes of interest. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The bias risk tool was used to assess the quality of studies considered to be at high risk of bias, as described in Fig. 2.…”

Section: Resultsmentioning

confidence: 99%

“…5) or mesh removal [Global effect test: Z = 0.11 (P = 0.92); Heterogeneity: Tau² = 0.00; Chi² = 0.86, df = 1 (P = 0.35); I² = 0%]. Regarding surgical site infection, we resolved the heterogeneity effect by conducting the analysis without the study that affected the funnel plot [7], still achieving a signi cant difference in favor of the polypropylene control group with acceptable heterogeneity [Test for overall effect: Z = 5.75 (P < 0.00001) Heterogeneity: Chi² = 6.33, df = 5 (P = 0.28); I² = 21%] (Fig. 3).…”

Section: Subgroup Analyisesmentioning

confidence: 99%

Metanalysis of Controlled Studies Comparing Biologic and Synthetic Unabsorbable Mesh in Contaminated Fields

CARVALHO,

GARCIA

2024

Preprint

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In 2019, approximately U$9.7 billion were invested in abdominal wall surgery in the United States. Additionally, opting for a biological mesh can increase the cost by more than $8,000 per surgery when compared to a polypropylene mesh. Knowing that, we conducted a meta-analysis evaluating controlled studies comparing biological and synthetic unabsorbable implanted on contaminated environments, with the primary outcome being Surgical Site Infection (SSI) and assessing other outcomes such as hernia recurrence, rehospitalization or reoperation, mesh removal, and hospitalization length of stay. Our systematic search was conducted on PubMed, EMBASE, and Cochrane in accordance with the PRSIMA guidelines, searching for controlled studies comparing the use of biologic mesh against synthetic polypropylene mesh in patients with Center of Disease Control infected site classification (CDC) class II or higher. We found 1036 studies, 20 were selected for full text review and 9 were included of comparative analysis of outcomes. Our analysis indicated a higher risk of SSI development in patients with biological mesh compared to synthetic mesh (P < 0.00001) and higher risk of hernia recurrence (P < 0.0001). Also, we did not observe apparently benefit for the biological mesh group in terms of reoperation (P = 0.54) or mesh removal (P = 0.92). Patients that were submitted to biological mesh implant had higher hospital length of stay (P = 0.004) and higher occurrence of intrabdominal infection (P = 0.05). Hence, we did not observe superiority in the use of biological mesh in contaminated environments concerning key post-operative complications. Moreover, the use of synthetic polypropylene mesh reduces the incidence of hernia recurrence with a lower risk SSI.

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Outcomes of biologic versus synthetic mesh in CDC class 3 and 4 open abdominal wall reconstruction

Cited by 12 publications

References 53 publications

Synthetic Versus Biological Mesh in Ventral Hernia Repair and Abdominal Wall Reconstruction: A Systematic Review and Recommendations from Evidence‐Based Medicine

Synthetic Versus Biological Mesh in Ventral Hernia Repair and Abdominal Wall Reconstruction: A Systematic Review and Recommendations from Evidence‐Based Medicine

Three-year follow-up of the grip concept: an open, prospective, observational registry study on biomechanically calculated abdominal wall repair for complex incisional hernias

Metanalysis of Controlled Studies Comparing Biologic and Synthetic Unabsorbable Mesh in Contaminated Fields

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