A Systematic Review of Outcomes Following Repair of Complex Ventral Incisional Hernias With Biologic Mesh

Abstract

Repair of contaminated/infected ventral incisional hernias is marked by high rates of recurrence, complications, and/or explantation of synthetic mesh. Biologic mesh products are recommended for repair to permit reconstruction and reduce complications. A systematic review of PubMed, EMBASE, and Cochrane databases identified Englishlanguage articles reporting postoperative outcomes (e.g., hernia recurrence, infection, mesh explantation) in patients undergoing contaminated/infected ventral incisional herniorrhaphy. Eleven studies met inclusion criteria and contained quantitative outcome data. All were retrospective chart reviews of biologic mesh use (mostly human acellular dermal matrix). Hernia recurrence and wound infection rates were highly variable and inconsistently reported across studies. Mesh explantation was rarely reported. Outcome variability is likely owing to heterogenous patient populations, surgical technique variations, and follow-up duration. Biologic mesh use in contaminated/infected herniorrhaphy was marked by low reported rates of secondary surgeries for infected mesh removal. Data from large, well-controlled, prospective trials with biologic mesh products are needed.

Defining the characteristics of certified hernia centers in Italy: The Italian society of hernia and abdominal wall surgery workgroup consensus on systematic reviews of the best available evidences

“…This concept as a matter of fact very well fits AWS: there's a high volume procedure (inguinal hernia repair) that requires repetition and appropriateness to maintain good outcome at low costs and, on the other hand, a low volume/high complexity clinical scenario represented by CAWR. This latter requires technical skills, clinical judgment and experience to be mastered correctly, moreover in light of the reported mortality [74,75,78] which places this type of surgery at highest position among hazardous subspecialties [102,103].…”

“…For SAWR cases the minimum reported value for mortality was 0% and the maximum 0.14% [76][77][78]. In CAWR cases [74,75] the reported mortality ranged from 0 to 5%.…”

“…Mean AMSTAR score for SAWR papers was 5.7, and 3.9 for CAWR. The commission decided to analyze all papers for SAWR [70][71][72] and CAWR [73][74][75][76][77][78][79]. Table 9 shows the characteristics of selected studies.…”

Laparoscopic repair of complicated umbilical hernia with Strattice Laparoscopic™ reconstructive tissue matrix

“…Biologic grafts allow conservative management of possible infections and reduces the need for downstream surgical interventions, such as explantation of infected prosthesis. 1,7 Additionally, utilization of biologic matrix requires tissue apposition, which subsequently promotes tissue regeneration and strengthening.…”

Single-stage repair of contaminated hernias using a novel antibiotic-impregnated biologic porcine submucosa tissue matrix

“…The use of synthetic materials for ventral hernia repair in contaminated fields has been controversial because a mesh infection may necessitate subsequent removal of the mesh in order to clear the infection [4][5][6][7][8]. Expert consensus and several systematic reviews recommend the use of biologic grafts when the risk of surgical site events is high, such as in the presence of gross contamination, because infection of biologic grafts can usually be managed conservatively without the requirement of surgical explantation [5,9,10]. However, infection has been postulated to be one of the main mechanisms for hernia recurrence [10,11], with recurrence rates of around 30% being reported for ventral hernia repair in contaminated settings [1,8,[12][13][14][15][16][17][18][19].…”