Biologic mesh is non-inferior to synthetic mesh in CDC class 1 &amp; 2 open abdominal wall reconstruction

Shao, Jenny M.; Ayuso, Sullivan A.; Deerenberg, Eva B.; Elhage, Sharbel A.; Prasad, T Krishna; Colavita, Paul D.; Augenstein, Vedra A.

doi:10.1016/j.amjsurg.2021.05.019

Cited by 14 publications

(15 citation statements)

References 28 publications

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“…Five studies reported fascial closure in 89.3% ( n = 626) of the patients. The fascial closure rate ranged from 40 to 100% in the included studies [8, 9, 16, 18, 19]. Five studies reported on component separation, with a component separation technique performed in 52.2% of patients ( n = 283) [8, 15, 17–19].…”

Section: Resultsmentioning

confidence: 99%

“…The mean BMI of the included patients was relatively high, from 26.9 (standard deviation, SD:5.7) to 38.6 (SD:9.6). Four studies were randomized controlled trials [8][9][10]18] while the remaining six were retrospective [13][14][15][16][17]19]. Nine studies reported the wound class in detail, and 30.1% of the patients had clean wounds (n = 346).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Five studies reported the location of the mesh [13,14,[17][18][19], and the majority of the mesh position were retro muscular (n = 357, 70.6%), followed by preperitoneal (n = 106, 20.9%). The surgical approach was open in six studies [8,9,[16][17][18][19], one study used both open and laparoscopic surgical techniques [10], and three studies did not report this. Overall, there was considerable variation in fascial closure rates across studies, as well as in component separation rates.…”

Section: Operative Techniquesmentioning

confidence: 99%

“…The results of the ROBINS-I and ROB2 showed that most of the included studies were of moderate quality [9,[13][14][15][16][17][18][19]. Common sources of bias for non-RCTs included the selection of participants and missing data.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

“…Finally, we identified 10 studies with 1305 patients based on the previously established inclusion and exclusion criteria (Fig. 1) [8][9][10][13][14][15][16][17][18][19]. The one of the most common reason for exclusion was that the studies had an apparent difference at baseline between the biological and synthetic mesh groups.…”

Section: Study Characteristicsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Operative Techniquesmentioning

confidence: 99%

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

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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Use of Biologic and Biosynthetic Mesh for Ventral Hernia Repair in Current Practice

Mullens,

Schoel,

McGee

et al. 2024

JAMA Surg

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ImportanceOriginally developed for use in contaminated fields, there is growing evidence against the use of biologic and biosynthetic mesh in ventral hernia repair. However, its prevalence and patterns of use in current practice are largely unknown.ObjectivesTo describe the prevalence of biologic and biosynthetic mesh use in ventral hernia repair and to identify factors associated with its use.Design, Setting, and ParticipantsThis retrospective cohort study used a statewide clinical registry in Michigan to identify adults who underwent mesh-based ventral hernia repair between January 1, 2021, and December 31, 2023. Data analysis was performed from February to May 2024.ExposuresUse of biologic or biosynthetic mesh vs synthetic mesh.Main Outcomes and MeasuresThe main outcome was use of biologic or biosynthetic mesh, abstracted directly from the operative report. Multivariable logistic regression was used to identify factors associated with use of biologic or biosynthetic mesh.ResultsA total of 10 838 patients (mean [SD] age, 55.7 [14.0] years; 4619 [42.6%] female) who underwent mesh-based ventral hernia repair were identified, among whom 1174 repairs (10.8%) were performed with biologic or biosynthetic mesh and 9664 (89.2%) were performed with synthetic mesh. Of the 1174 cases using biologic or biosynthetic mesh, 1023 (87.1%) had a clean wound classification and 1039 (88.5%) were performed electively. In multivariable logistic regression, wound contamination was associated with increased odds of biologic or biosynthetic mesh use (clean-contaminated: adjusted odds ratio [aOR], 2.17 [95% CI, 1.62-2.89]; contaminated: aOR, 2.95 [95% CI, 1.63-5.34]; dirty or infected: aOR, 36.22 [95% CI, 12.20-107.56]). Other operative factors associated with increased odds of biologic or biosynthetic mesh use included urgent or emergent surgical priority (aOR, 1.69 [95% CI, 1.33-2.16]), laparoscopic or robotic approach (aOR, 1.31 [95% CI, 1.15-1.50]), larger hernia width (aOR, 1.03 [95% CI, 1.01-1.04] per centimeter), and use of myofascial release (aOR, 2.10 [95% CI, 1.64-2.70]).Conclusions and RelevanceIn this large cohort of patients undergoing ventral hernia repair, 1 in 10 mesh-based repairs was performed with biologic or biosynthetic mesh. Although urgent or emergent repair and wound contamination were associated with increased odds of biologic or biosynthetic mesh use, nearly 90% of biologic and biosynthetic mesh use occurred in elective repairs with clean wound classifications. These results raise questions regarding the appropriateness of its application in current practice.

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Outcomes of Complex Abdominal Wall Reconstruction with Biologic Mesh in Patients with 8 Years of Follow‐Up

Hassan,

Franco,

Shah

et al. 2023

World j. surg.

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Background While many studies evaluated outcomes of abdominal wall reconstruction with biologic mesh, longterm data is lacking. In this study, we sought to analyze the outcomes of complex AWR with biologic mesh in a robust cohort of patients with a mean follow up of 8 years. Methods We conducted a longitudinal study of AWR patients from 2005 to 2019. Hernia recurrence was the primary outcome, and surgical site occurrence was the secondary outcome. Predictive/protective factors were identified using a Cox proportional hazards regression models. Results We identified 109 consecutive patients who met the inclusion criteria. Patient's mean (± SD) age was 57.5 ± 11.8 years, mean body mass index was 30.7 ± 7.2 kg/m 2 , and mean follow-up time was 96.2 ± 15.9 months. Fifty-six percent had clean defects, 34% had clean-contaminated defects, and 10% had contaminated/infected defects. Patients had a mean defect size of 261 ± 199.6 cm 2 and mean mesh size of 391.3 ± 160.2 cm 2 . Nineteen patients (17.4%) developed HR at the final follow-up date. Obesity was independently associated with a four-fold higher risk of HR (hazard ratio, 3.98; 95%CI, 1.34 to 14.60, p = 0.02). SSOs were identified in 24.8% of patients. A prior hernia repair was associated with a three-fold higher risk of SSOs (Odds ratio, 3.13; 95%CI, 1.10 to 8.94, p = 0.03). No patient developed mesh infection. Conclusion These longitudinal data demonstrate that complex AWR with biologic mesh provides long-term durable outcomes with acceptable HR and SSO rates despite high contamination levels, patients complexity, and large defect size.

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Biologic mesh is non-inferior to synthetic mesh in CDC class 1 & 2 open abdominal wall reconstruction

Cited by 14 publications

References 28 publications

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

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

Use of Biologic and Biosynthetic Mesh for Ventral Hernia Repair in Current Practice

Outcomes of Complex Abdominal Wall Reconstruction with Biologic Mesh in Patients with 8 Years of Follow‐Up

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