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

Abstract

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.

Outcomes and Quality of Life After Resorbable Synthetic Ventral Hernia Repair in Contaminated Fields

“…Despite concerns with synthetic mesh, Rosen et al 11 have successfully demonstrated that it can be considered in contaminated VHR when placed in the retromuscular position with superior outcomes to biologic mesh. Other studies reflect this shift toward using synthetic mesh in certain contaminated environments 29,32–34 . Our results demonstrate that the use of biosynthetic mesh shows similar outcomes to synthetic mesh, making P4HB a viable option for surgeons due to its relatively low infection rates and sustained QoL improvement.…”

“…The concern of infection due to contamination has led surgeons to avoid permanent synthetic mesh. Some recent studies continue to affirm an increased risk of infection and complications when using synthetic mesh 29 . However, biologic mesh has unacceptable rates of recurrence and complication despite its high cost 17,30,31 .…”

Acute Repair of Traumatic Lumbar Hernia with Fascia Lata Autograft

“…Stronger repair may have been achieved if direct fixation of the iliac crest was performed at the time of fascial fixation, as these reports 15,16) . Mesh reconstruction is now the gold standard for hernia treatment but often results in recurrent hernias or necessitates additional treatment due to foreign body infection 17,18) . In cases of repetitive recurrence after mesh reconstruction, concomitant infection, and large defects, alternative reconstruction methods include fasciocutaneous flaps, including tensor fascia lata flaps and fascia lata autografts [19][20][21] .…”

Decellularization of Dense Regular Connective Tissue—Cellular and Molecular Modification with Applications in Regenerative Medicine

“…There are no reports of the effect of decellularized tissue on hydroxyproline and hydroxylysine synthesis during the tissue regeneration process. Injury of a tendon, ligament or fascia, especially in athletes, puts returning to preinjury functionality at risk [ 65 , 66 , 67 ]. The limbs with healed ligaments or tendons achieve lower results and asymmetricity in athletic performance [ 68 , 69 ].…”