What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction?

Abstract

IntroductionAlthough many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations.MethodsA European working group, “BioMesh Study Group”, composed of invited surgeons with a special interest in surgical meshes, formulated key questions, and forwarded them for processing in subgroups. In January 2016, a workshop was held in Berlin where the findings were presented, discussed, and voted on for consensus. Findings were set out in writing by the subgroups followed by consensus being reached. For the review, 114 studies and background analyses were used.ResultsThe cumulative data regarding biologic mesh under contaminated conditions do not support the claim that it is better than synthetic mesh. Biologic mesh use should be avoided when bridging is needed. In inguinal hernia repair biologic and biosynthetic meshes do not have a clear advantage over the synthetic meshes. For prevention of incisional or parastomal hernias, there is no evidence to support the use of biologic/biosynthetic meshes. In complex abdominal wall hernia repairs (incarcerated hernia, parastomal hernia, infected mesh, open abdomen, enterocutaneous fistula, and component separation technique), biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes.ConclusionThe routine use of biologic and biosynthetic meshes cannot be recommended.

Long-term outcomes after contaminated complex abdominal wall reconstruction

“…A recent systematic review and meta-analysis [8] including 32 studies showed comparable results for synthetic and biologic meshes in terms of hernia recurrence for potentially contaminated repairs, but higher recurrence rates were seen in contaminated repairs using biologic mesh. A more recent paper questions the use of biologic mesh altogether if compared to synthetic mesh, but highlighting the very low level of evidence in the field of CAWR [21]. Our data clearly show that there is an inevitable bias in comparing synthetic and biologic mesh.…”

“…Long-term gains outweigh the initial high cost, considering that the overall survival in this group is good and the majority of patients do not undergo any further surgery and are subsequently weaned of PN. In this series, only non-crosslinked biologic mesh were used as several studies show poor results with cross-linked biologic mesh with high numbers of surgical site occurrence, mesh removal and fistulation [9,10,[21][22][23]. However, appropriate patient selection for the use of a non-crosslinked biologic mesh is of utmost importance, and studies to assess cost-effectiveness are needed.…”

Comments to “PRevention of INCisional hernia after liver transplantation (PRINC trial): study protocol for a randomized controlled trial.”

“…Juvany and colleagues have found that, in half of the patients who developed incisional hernia, it occurred more than 3 years from the original procedure [7]. Kockerling et al proved that in a complex abdominal hernia repair, biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes [8]. The use of poly-4hydroxybutyrate mesh to repair incisional hernia in a high-risk group of patients, resulted in a 9% recurrence rate in the 18-month follow-up [9].…”

“…The use of poly-4hydroxybutyrate mesh to repair incisional hernia in a high-risk group of patients, resulted in a 9% recurrence rate in the 18-month follow-up [9]. There is no evidence to support the use of biologic/biosynthetic meshes for prevention of incisional hernias [8].…”

Which mesh should be used to repair abdominal wall defect in peritonitis? An experimental study

“…1,[5][6][7][8][9][10][11][12][13] Researchers have yet to reach a consensus regarding the type of material to be used. [14][15][16] A Bogota bag is often preferred because it is far more inexpensive and available compared to the other materials; however, PTFE or PP mesh is often used to close the abdominal wall defect after the removal of the Bogota bag.…”