The use of synthetic mesh in contaminated and infected abdominal wall repairs: challenging the dogma—A long-term prospective clinical trial

Birolini, Cláudio; Miranda, Jocielle Santos de; Tanaka, Eduardo; Utiyama, Edivaldo Massazo; Rasslan, Samir; Birolini, D

doi:10.1007/s10029-019-02035-2

Cited by 37 publications

(32 citation statements)

References 37 publications

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“…Other studies [ 1 , 27 , 33 ] have reported similar success of prosthetic mesh repair in the management of complicated VH. None of 18 patients reported in the study of Bessa et al [ 27 ] who had resection-anastomosis of necrosis small intestine developed SSI and authors concluded that there is no correlation between bowel resection and SSI.…”

Section: Discussionmentioning

confidence: 68%

“…Finally, 13 studies entered the meta-analysis model. Included studies were either RCT (n = 1) [ 26 ], prospective studies (n = 3) [ 1 , 6 , 27 ], retrospective studies (n = 5) [ 25 , [28] , [29] , [30] , [31] ] and database reviews(n = 4) [ 16 , [32] , [33] , [34] ].…”

Section: Resultsmentioning

confidence: 99%

“…Five studies [ 1 , 27 , 28 , 31 , 33 ] evaluated wound infection occurrence by field contamination. We performed two sets of analysis following the CDC wound classification:…”

Section: Resultsmentioning

confidence: 99%

“…The purpose of three studies [ 1 , 27 , 33 ] was to establish whether the use of mesh is safe in clean-contaminated, contaminated and dirty field (CDC wound classes II, III and IV) with the clean wound class data (CDC wound class I).…”

Section: Resultsmentioning

confidence: 99%

“…In the prospective study by Birolini et al [ 1 ]., 40 patients underwent operations for complicated VHR with synthetic mesh in dirty-infected field (Class IV) compared to a cohort of 40 patients with clean ventral hernia repairs. Similar infection rates were reported in the clean and infected group (10% vs 15% respectively, p = 0.499).…”

Section: Discussionmentioning

confidence: 99%

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Surgical site infection in mesh repair for ventral hernia in contaminated field: A systematic review and meta-analysis

Maatouk

Safta

Mabrouk

et al. 2021

Annals of Medicine &Amp; Surgery

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Background Given the risk of surgical site infection (SSI), the use of mesh in contaminated ventral hernia repair (VHR) is not standardized and still a clinical dilemma. This meta-analysis aimed to assess whether mesh use increased the risk of SSI in patients following VHR in contaminated field. Methods We performed a systematic review of published literature. Studies comparing the mesh repair and anatomic repair, the use of mesh in different Center for Disease Control and Prevention (CDC) wound classes and mesh repair with synthetic mesh or other type of meshes to treat complicated and contaminated VHR were considered for analysis. The main outcome was SSI incidence. Results Six studies compared mesh and suture repairs. No significant difference in SSI incidence was observed between patients with complicated VHR in the mesh and suture repair groups. Five studies analyzed mesh repair in patients by field contamination level. There was no significant difference between the use of mesh in clean-contaminated, contaminated and dirty field versus clean wound class. Moreover, there was no significant difference between the use of mesh in clean-contaminated and contaminated cases. Four studies compared mesh repair technique with synthetic mesh or other type of meshes were included. The incidence of SSI was significantly lower in the synthetic mesh group. Conclusions The use of mesh repair in the management of complicated VHR compared to suture repair is not associated with an increased incidence of SSI even in potentially contaminated fields.

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Section: Discussionmentioning

confidence: 68%

Section: Resultsmentioning

confidence: 99%

“…Five studies [ 1 , 27 , 28 , 31 , 33 ] evaluated wound infection occurrence by field contamination. We performed two sets of analysis following the CDC wound classification:…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical site infection in mesh repair for ventral hernia in contaminated field: A systematic review and meta-analysis

Maatouk

Safta

Mabrouk

et al. 2021

Annals of Medicine &Amp; Surgery

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Biologic vs Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias

et al. 2022

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IMPORTANCE Biologic mesh is widely used for reinforcing contaminated ventral hernia repairs; however, it is expensive and has been associated with high rates of long-term hernia recurrence. Synthetic mesh is a lower-cost alternative but its efficacy has not been rigorously studied in individuals with contaminated hernias. OBJECTIVE To determine whether synthetic mesh results in superior reduction in risk of hernia recurrence compared with biologic mesh during the single-stage repair of clean-contaminated and contaminated ventral hernias. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, single-blinded randomized clinical trial was conducted from December 2012 to April 2019 with a follow-up duration of 2 years. The trial was completed at 5 academic medical centers in the US with specialized units for abdominal wall reconstruction. A total of 253 adult patients with clean-contaminated or contaminated ventral hernias were enrolled in this trial. Follow-up was completed in April 2021.INTERVENTIONS Retromuscular synthetic or biologic mesh at the time of fascial closure. MAIN OUTCOMES AND MEASURESThe primary outcome was the superiority of synthetic mesh vs biologic mesh at reducing risk of hernia recurrence at 2 years based on intent-to-treat analysis. Secondary outcomes included mesh safety, defined as the rate of surgical site occurrence requiring a procedural intervention, and 30-day hospital direct costs and prosthetic costs.RESULTS A total of 253 patients (median [IQR] age, 64 [55-70] years; 117 [46%] male) were randomized (126 to synthetic mesh and 127 to biologic mesh) and the follow-up rate was 92% at 2 years. Compared with biologic mesh, synthetic mesh significantly reduced the risk of hernia recurrence (hazard ratio, 0.31; 95% CI, 0.23-0.42; P < .001). The overall intent-to-treat hernia recurrence risk at 2 years was 13% (33 of 253 patients). Recurrence risk with biologic mesh was 20.5% (26 of 127 patients) and with synthetic mesh was 5.6% (7 of 126 patients), with an absolute risk reduction of 14.9% with the use of synthetic mesh (95% CI, −23.8% to −6.1%; P = .001). There was no significant difference in overall 2-year risk of surgical site occurrence requiring a procedural intervention between the groups (odds ratio, 1.22; 95% CI, 0.60-2.44; P = .58). Median (IQR) 30-day hospital direct costs were significantly greater in the biologic group vs the synthetic group

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Abdominal Wall Repair in Intestinal Failure

Mehta,

Walsh

2023

Intestinal Failure

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The use of synthetic mesh in contaminated and infected abdominal wall repairs: challenging the dogma—A long-term prospective clinical trial

Cited by 37 publications

References 37 publications

Surgical site infection in mesh repair for ventral hernia in contaminated field: A systematic review and meta-analysis

Surgical site infection in mesh repair for ventral hernia in contaminated field: A systematic review and meta-analysis

Biologic vs Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias

Abdominal Wall Repair in Intestinal Failure

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