S Morales-Conde1, P Hernández-Granados2, L Tallón-Aguilar3, M Verdaguer-Tremolosa4, M López-Cano4. 1. Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain. 2. General Surgery Unit, Fundación Alcorcón University Hospital, Rey Juan Carlos University, Alcorcón, Spain. 3. Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitario Virgen del Rocío, c/ Asuncion 26, 2ºA, 41011, Seville, Spain. ltallona@hotmail.com. 4. Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
Abstract
PURPOSE: The use of mesh is a common practice in ventral hernia repair (VHR). Lack of consensus on which prosthetic material works better in different settings remains. This meta-analysis aims to summarize the available evidence on hernia recurrence and complications after repair with synthetic, biologic, or biosynthetic/bioabsorbable meshes in hernias grade 2-3 of the Ventral Hernia Working Group modified classification. METHODS: A literature search was conducted in January 2021 using Web of Science (WoS), Scopus, and MEDLINE (via PubMed) databases. Randomized Controlled Trials (RCTs) and observational studies with adult patients undergoing VHR with either synthetic, biologic, or biosynthetic/bioabsorbable mesh were included. Outcomes were hernia recurrence, Surgical Site Occurrence (SSO), Surgical Site Infection (SSI), 30 days re-intervention, and infected mesh removal. Random-effects meta-analyses of pooled proportions were performed. Quality of the studies was assessed, and heterogeneity was explored through sensitivity analyses. RESULTS: 25 articles were eligible for inclusion. Mean age ranged from 47 to 64 years and participants' follow-up ranged from 1 to 36 months. Biosynthetic/bioabsorbable mesh reported a 9% (95% CI 2-19%) rate of hernia recurrence, lower than synthetic and biologic meshes. Biosynthetic/bioabsorbable mesh repair also showed a lower incidence of SSI, with a 14% (95% CI 6-24%) rate, and there was no evidence of infected mesh removal. Rates of seroma were similar for the different materials. CONCLUSIONS: This meta-analysis did not show meaningful differences among materials. However, the best proportions towards lower recurrence and complication rates after grade 2-3 VHR were after using biosynthetic/slowly absorbable mesh reinforcement. These results should be taken with caution, as head-to-head comparative studies between biosynthetic and synthetic/biologic meshes are lacking. Although, biosynthetic/bioabsorbable materials could be considered an alternative to synthetic and biologic mesh reinforcement in these settings.
PURPOSE: The use of mesh is a common practice in ventral hernia repair (VHR). Lack of consensus on which prosthetic material works better in different settings remains. This meta-analysis aims to summarize the available evidence on hernia recurrence and complications after repair with synthetic, biologic, or biosynthetic/bioabsorbable meshes in hernias grade 2-3 of the Ventral Hernia Working Group modified classification. METHODS: A literature search was conducted in January 2021 using Web of Science (WoS), Scopus, and MEDLINE (via PubMed) databases. Randomized Controlled Trials (RCTs) and observational studies with adult patients undergoing VHR with either synthetic, biologic, or biosynthetic/bioabsorbable mesh were included. Outcomes were hernia recurrence, Surgical Site Occurrence (SSO), Surgical Site Infection (SSI), 30 days re-intervention, and infected mesh removal. Random-effects meta-analyses of pooled proportions were performed. Quality of the studies was assessed, and heterogeneity was explored through sensitivity analyses. RESULTS: 25 articles were eligible for inclusion. Mean age ranged from 47 to 64 years and participants' follow-up ranged from 1 to 36 months. Biosynthetic/bioabsorbable mesh reported a 9% (95% CI 2-19%) rate of hernia recurrence, lower than synthetic and biologic meshes. Biosynthetic/bioabsorbable mesh repair also showed a lower incidence of SSI, with a 14% (95% CI 6-24%) rate, and there was no evidence of infected mesh removal. Rates of seroma were similar for the different materials. CONCLUSIONS: This meta-analysis did not show meaningful differences among materials. However, the best proportions towards lower recurrence and complication rates after grade 2-3 VHR were after using biosynthetic/slowly absorbable mesh reinforcement. These results should be taken with caution, as head-to-head comparative studies between biosynthetic and synthetic/biologic meshes are lacking. Although, biosynthetic/bioabsorbable materials could be considered an alternative to synthetic and biologic mesh reinforcement in these settings.
Authors: B C Shah; M M Tiwari; M R Goede; M J Eichler; R R Hollins; C L McBride; J S Thompson; D Oleynikov Journal: Hernia Date: 2010-12-28 Impact factor: 4.739
Authors: Hobart W Harris; Frank Primus; Charlotte Young; Jonathan T Carter; Matthew Lin; Rita A Mukhtar; Benjamin Yeh; Isabel E Allen; Chris Freise; Esther Kim; Hani Sbitany; David M Young; Scott Hansen Journal: Ann Surg Date: 2021-04-01 Impact factor: 12.969
Authors: M P Morris; J A Mellia; A N Christopher; M N Basta; V Patel; K Qiu; R B Broach; J P Fischer Journal: Hernia Date: 2021-01-19 Impact factor: 4.739
Authors: Karl Breuing; Charles E Butler; Stephen Ferzoco; Michael Franz; Charles S Hultman; Joshua F Kilbridge; Michael Rosen; Ronald P Silverman; Daniel Vargo Journal: Surgery Date: 2010-03-20 Impact factor: 3.982
Authors: Mathilde Mj van Rooijen; An P Jairam; Tim Tollens; Lars N Jørgensen; Tammo S de Vries Reilingh; Guillaume Piessen; Ferdinand Köckerling; Marc Miserez; Alastair Cj Windsor; Frederik Berrevoet; René H Fortelny; Bertrand Dousset; Guido Woeste; Henderik L van Westreenen; Francesco Gossetti; Johan F Lange; Geert Wm Tetteroo; Andreas Koch; Leonard F Kroese; Johannes Jeekel Journal: Int J Surg Date: 2020-09-12 Impact factor: 6.071
Authors: Michael J Rosen; Joel J Bauer; Marco Harmaty; Alfredo M Carbonell; William S Cobb; Brent Matthews; Matthew I Goldblatt; Don J Selzer; Benjamin K Poulose; Bibi M E Hansson; Camiel Rosman; James J Chao; Garth R Jacobsen Journal: Ann Surg Date: 2017-01 Impact factor: 12.969