Ventral hernia repair in high-risk patients and contaminated fields using a single mesh: proportional meta-analysis

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. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-022-02668-w.

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

“…Our study builds on several previously published meta‐analyses [11, 12, 28]. Morales‐Conde et al conducted a single‐arm meta‐analysis of articles reporting the outcomes of biological and synthetic meshes [11]. This study had several limitations.…”

“…Several meta‐analyses have compared the efficacy and safety of synthetic and biological meshes in VHR [11, 12]. The evidence from these meta‐analyses is weak, mainly because most of the included clinical trials had non‐comparative designs.…”

Metanalysis of Controlled Studies Comparing Biologic and Synthetic Unabsorbable Mesh in Contaminated Fields

“…Reviews published approximately a decade ago already raised questions about the performance of biological matrices in contaminated environments [3,23,24]. Even though the concept of a biological collagen framework serving as a stabilizer for the abdominal wall was proposed, there are no guarantees that the integration process of the mesh would be replaced by a reaction to a foreign body.…”

“…However, in the previous studies recruited only series of cases, using only one of the matrices in contaminated environments, and the outcomes of the recruited studies were separately evaluated. [3,24].…”

Double‐Layer Asymmetric Porous Mesh with Dynamic Mechanical Support Properties Enables Efficient Single‐Stage Repair of Contaminated Abdominal Wall Defect

“…[ 8,11 ] In recent decades, biological meshes have emerged as the preferred materials for repairing contaminated abdominal wall defect owing to their good tissue remodeling capabilities and ability to withstand contamination. [ 12–16 ] Unfortunately, biological meshes, such as small intestinal submucosal decellularized matrix (SIS), exhibit in vivo degradation within 3 months and are unable to offer sustained bio‐adaptive mechanical support for the reconstruction of abdominal wall defect. [ 17 ] Secondary surgery is usually inevitable due to the high recurrence risk (ranging from 30% to 50%) caused by the above inherent drawbacks of biological meshes [ 16,18 ] ( Figure a).…”