Ventral hernia repair with synthetic mesh in a contaminated field: a systematic review and meta-analysis

Morris, Martin P.; Mellia, Joseph A.; Christopher, Adrienne N.; Basta, Marten N.; Patel, Viren; Qiu, Kai; Broach, Robyn B.; Fischer, John P.

doi:10.1007/s10029-020-02358-5

Cited by 13 publications

(17 citation statements)

References 49 publications

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“…38 This raises the question of the suitability and cost-effectiveness of using biological mesh instead of macroporous polypropylene mesh in both clean or contaminated ventral hernia surgery. 14,[39][40][41] Poly-4-hydroxybutyrate monofilament biosynthetic mesh in clean or contaminated VHR appears a reliable and cost-effective long-term alternative to biological or non-absorbable synthetic mesh, but its use is still being evaluated. 42 A synchronous hernia mesh repair should not be contraindicated during other intra-abdominal operations (appendicectomy, cholecystectomy, small bowel resection).…”

Section: Absorbable Vs Permanent Meshmentioning

confidence: 99%

“…8,9,11 An extraperitoneal mesh repair (retrorectus or onlay) rather than intraperitoneal mesh repair is preferable in contaminated VHR, emergency VHR, emergency laparotomy or with concurrent colorectal surgery. 9,11,40,41 Some surgical societies including the WSES and the Ventral Hernia Working Group advocate the use of simple suture or biological mesh in contaminated/dirty VHR cases. However, this approach has not been shown to be superior to macroporous polypropylene VHR with respect to SSI, surgical site occurrence (SSO), unplanned re-operation, cost or hernia recurrence in recent systematic reviews 11,37,40,41 (Fig.…”

Section: Absorbable Vs Permanent Meshmentioning

confidence: 99%

“…9,11,40,41 Some surgical societies including the WSES and the Ventral Hernia Working Group advocate the use of simple suture or biological mesh in contaminated/dirty VHR cases. However, this approach has not been shown to be superior to macroporous polypropylene VHR with respect to SSI, surgical site occurrence (SSO), unplanned re-operation, cost or hernia recurrence in recent systematic reviews 11,37,40,41 (Fig. 3).…”

Section: Absorbable Vs Permanent Meshmentioning

confidence: 99%

“…Over-all, the use of absorbable mesh was associated with a 2.84 increased OR (95% CI) of SSI. Reproduced by permission 41 2. Patient selection and preparation (control of patient comorbidities, patient prehabilitation, MRSA decolonization, pre-operative soap/antiseptic body wash, avoidance of skin shaving, chlorhexidine gluconate 2% in isopropyl 70% alcohol antiseptic solution for preparation of the operative skin site, prevention of perioperative hypothermia/hypoxia, perioperative glycaemic control, proper selection, dosage and timing of administration of systemic antibiotic prophylaxis prior to surgical incision).…”

Section: Controllable Risk Factors For Ssimentioning

confidence: 99%

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Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP

Wilson

Farooque

2022

Journal of Gastrointestinal Surgery

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Aim The aim of this paper was to provide a narrative review of surgical site infection after hernia surgery and the influence of perioperative preventative interventions. Methods The review was based on current national and international guidelines and a literature search. Results Mesh infection is a highly morbid complication after hernia surgery, and is associated with hospital re-admission, increased health care costs, re-operation, hernia recurrence, impaired quality of life and plaintiff litigation. The American College of Surgeons National Surgical Quality Improvement Program is a particularly useful resource for the study and evidence-based practise of abdominal wall hernia repair. Discussion The three major modifiable patient comorbidities significantly associated with postoperative surgical site infection in hernia surgery are obesity, tobacco smoking and diabetes mellitus. Preoperative optimization includes weight loss, cessation of smoking, and control of diabetes. Intraoperative interventions relate, in particular, to the control of fomite mediated transmission in the operating theatre and prevention of mesh contamination with S. aureus CFUs. Risk management strategies should also target the niche ecological conditions which enable bacterial survival and subsequent biofilm formation on an implanted mesh. Outcomes of mesh infection after hernia surgery are closely related to mesh type and porosity, patient smoking status, presence of MRSA, bacterial adhesion and biofilm production. The use of suction drains and the timing of drain removal are controversial and discussed in detail. Finally, the utility of the ACS-NSQIP Surgical Risk Calculator in predicting complications and outcomes in individual patients and the importance of quality improvement initiatives in surgical units are emphasized.

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Section: Absorbable Vs Permanent Meshmentioning

confidence: 99%

Section: Absorbable Vs Permanent Meshmentioning

confidence: 99%

Section: Absorbable Vs Permanent Meshmentioning

confidence: 99%

Section: Controllable Risk Factors For Ssimentioning

confidence: 99%

See 2 more Smart Citations

Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP

Wilson

Farooque

2022

Journal of Gastrointestinal Surgery

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“…Bei dem Vorliegen einer Peritonitis, freier Flüssigkeit oder eines Abszesses sollte meist keine Netzimplantation durchgeführt werden. Eine neueste Metaanalyse über "mesh repair" ventraler Hernien zeigt, dass das "mesh" auch in kontami-nierteArealeneingebrachtwerden darf [6]. Bei stabilem klinischem Befund und ohne Kompromittierung der Weichteile, wie in dem dargestellten Fall, haben wir uns für das endoskopische transabdominelle Vorgehen mit Netzimplantation entschieden.…”

Section: Befundunclassified

Patientin mit Fieber und rechtsseitigen Leistenschmerzen

Morić¹,

Romić

Silovski³

et al. 2021

Chirurg

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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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Ventral hernia repair with synthetic mesh in a contaminated field: a systematic review and meta-analysis

Cited by 13 publications

References 49 publications

Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP

Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP

Patientin mit Fieber und rechtsseitigen Leistenschmerzen

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

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