Synthetic versus Biologic Mesh in Single-Stage Repair of Complex Abdominal Wall Defects in a Contaminated Field

Chamieh, Jad; Tan, Wen Hui; Ramirez, Ricardo; Nohra, Eden; Apakama, Chukwuma; Symons, William J.

doi:10.1089/sur.2016.106

Cited by 40 publications

(53 citation statements)

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“…The degree of contamination in all studies was clean-contaminated. Mesh placement was reported as intraperitoneal in five studies 34,35,42,44,46 , extraperitoneal in seven 30,32,33,37,40,48,50 and a combination in ten studies 29,31,36,38,39,41,43,45,47,49 . One study 28 26 2015 Greece Prophylaxis Bovine pericardium 36 Maggiori et al 24 2015 France Prophylaxis Strattice™ 17 Ueno et al 29 2004 USA Reinforcement Surgisis ® 16 Limpert et al 37 2009 USA Reinforcement Bovine pericardium 22 Hsu et al 35 2009 USA Reinforcement Permacol™ 16 Chavarriaga et al 32 2010 USA Reinforcement Permacol™ 7 Cox et al 48 2010 USA Reinforcement Surgisis ® 10 Shah et al 45 2011 elective and emergency operations.…”

Section: Ideal Stage Of Innovation and Grade Quality Of Evidencementioning

confidence: 99%

“…Seven 29,31,38,40,48 -50 were of very low quality, 14 30,32 -37,39,42-47 of low quality, and two 28,41 of moderate quality. None reported standardization of technique or location of biological mesh placement; the choice of mesh type was based on the preference of operating surgeon.Of the eight studies evaluating biological mesh for mixed indications, four included patients undergoing elective surgery and the remaining four studies included both…”

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confidence: 95%

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Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure

et al. 2018

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BackgroundAchieving stable closure of complex or contaminated abdominal wall incisions remains challenging. This study aimed to characterize the stage of innovation for biological mesh devices used during complex abdominal wall reconstruction and to evaluate the quality of current evidence.MethodsA systematic review was performed of published and ongoing studies between January 2000 and September 2017. Eligible studies were those where a biological mesh was used to support fascial closure, either prophylactically after midline laparotomy, or for reinforcement after repair of incisional hernia with midline incision. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measure was the GRADE criteria for study quality.ResultsThirty‐five studies including 2681 patients were included. Four studies considered mesh prophylaxis, 23 considered hernia repair, and eight reported on both. There was one published randomized trial (IDEAL stage 3), none of which was of high quality; the others were non‐randomized studies (IDEAL stage 2a). A detailed description of surgical technique was provided in most studies (27 of 35); however, no study reported outcomes according to the European Hernia Society consensus statement and only two described quality control of surgical technique during the study. From 21 ongoing randomized trials and observational studies, 11 considered repair of incisional hernia and 10 considered prophylaxis (seven in elective settings).ConclusionThe evidence base for biological mesh is limited, and better reporting and quality control of surgical techniques are needed. Although results of ongoing trials over the next decade will improve the evidence base, further study is required in the emergency and contaminated settings.

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Section: Ideal Stage Of Innovation and Grade Quality Of Evidencementioning

confidence: 99%

mentioning

confidence: 95%

Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure

et al. 2018

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“…Las TPN han marcado un importante punto de inflexión, significando el mayor avance en las técnicas de cierre parietal temporal 103,104,18,[109][110][111]114,146,157 . El método consiste en colocar una lámina no adherente multifenestrada cubriendo las vísceras abdominales, extendiéndola lateralmente hasta las goteras parietocólicas, hacia arriba hasta los espacios subfrénicos y hacia abajo hasta la pelvis menor.…”

Section: Cierre Asistido Por Vacíounclassified

“…Cuando se toma la decisión de no unir los bordes aponeuróticos luego de una laparotomía para el control de daños, la hernia ventral es la consecuencia inevitable 23,151,152,[156][157][158] (Fig. 45).…”

Section: Hernia Incisionalunclassified

“…La hipótesis del trabajo fue si la malla de material sintético se puede utilizar para reparar los defectos de la pared abdominal contaminada, con resultados desde el punto de vista infectológico comparables al uso de mallas biológicas 157 . Resultados: la estancia hospitalaria y el índice de reingresos fueron mayores en los pacientes con prótesis biológicas.…”

Section: Mallas Sintéticas Vs Biológicasunclassified

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Manejo Del Abdomen Abierto: Desde La Operación Inicial Al Cierre Definitivo

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2017

Rev Argent Cirug

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Biologic vs Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias

et al. 2022

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IMPORTANCE Biologic mesh is widely used for reinforcing contaminated ventral hernia repairs; however, it is expensive and has been associated with high rates of long-term hernia recurrence. Synthetic mesh is a lower-cost alternative but its efficacy has not been rigorously studied in individuals with contaminated hernias. OBJECTIVE To determine whether synthetic mesh results in superior reduction in risk of hernia recurrence compared with biologic mesh during the single-stage repair of clean-contaminated and contaminated ventral hernias. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, single-blinded randomized clinical trial was conducted from December 2012 to April 2019 with a follow-up duration of 2 years. The trial was completed at 5 academic medical centers in the US with specialized units for abdominal wall reconstruction. A total of 253 adult patients with clean-contaminated or contaminated ventral hernias were enrolled in this trial. Follow-up was completed in April 2021.INTERVENTIONS Retromuscular synthetic or biologic mesh at the time of fascial closure. MAIN OUTCOMES AND MEASURESThe primary outcome was the superiority of synthetic mesh vs biologic mesh at reducing risk of hernia recurrence at 2 years based on intent-to-treat analysis. Secondary outcomes included mesh safety, defined as the rate of surgical site occurrence requiring a procedural intervention, and 30-day hospital direct costs and prosthetic costs.RESULTS A total of 253 patients (median [IQR] age, 64 [55-70] years; 117 [46%] male) were randomized (126 to synthetic mesh and 127 to biologic mesh) and the follow-up rate was 92% at 2 years. Compared with biologic mesh, synthetic mesh significantly reduced the risk of hernia recurrence (hazard ratio, 0.31; 95% CI, 0.23-0.42; P < .001). The overall intent-to-treat hernia recurrence risk at 2 years was 13% (33 of 253 patients). Recurrence risk with biologic mesh was 20.5% (26 of 127 patients) and with synthetic mesh was 5.6% (7 of 126 patients), with an absolute risk reduction of 14.9% with the use of synthetic mesh (95% CI, −23.8% to −6.1%; P = .001). There was no significant difference in overall 2-year risk of surgical site occurrence requiring a procedural intervention between the groups (odds ratio, 1.22; 95% CI, 0.60-2.44; P = .58). Median (IQR) 30-day hospital direct costs were significantly greater in the biologic group vs the synthetic group

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Synthetic versus Biologic Mesh in Single-Stage Repair of Complex Abdominal Wall Defects in a Contaminated Field

Abstract: Our results show that synthetic meshes are not inferior to biologic meshes in contaminated AWR. This is important in view of the tremendous cost disparity between these two products and the questionable ability of biologic mesh to offer a durable hernia repair.

Cited by 40 publications

References 28 publications

Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure

Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure

Manejo Del Abdomen Abierto: Desde La Operación Inicial Al Cierre Definitivo

Biologic vs Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias

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