Risk and benefit evaluations of biological <i>versus</i> synthetic mesh for ventral hernia repair: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yunfeng ¹ ,  YU Yongjiang ^1,2 , YU Kun ¹ , SUN Binjie ¹ , JIANG Weirong ¹

1. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, P. R. China;
2. Department of Gastrointestinal Hernia and Abdominal Wall Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding author：

YU Yongjiang, Email: ylongy@163.com

Keywords：

ventral hernia; biological mesh; synthetic mesh; risk; meta-analysis

DOI：

10.7507/1007-9424.202109064

Video：

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Objective To systematically evaluate the effects of biological mesh (BM) and non-absorbable synthetic mesh (SM) on the risks of recurrence, complications, and cost-effectiveness after ventral hernia repair. Methods The publicly published related researches of BM versus SM for ventral hernia repair were searched in the PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, CBM databases from the establishment of the databases to August 1, 2021. According to the inclusion and exclusion criteria, the literatures were screened and the data were extracted, and the data that met the conditions were merged and analyzed. The meta-analysis was performed by RevMan5.4.1 software. Results A total of 26 studies with 3 259 patients were included, including 1 388 patients in the BM group and 1 871 in the SM group. The results of meta-analysis showed that the recurrence, surgical site infection, surgical site occurrence, reoperation rates, and medical costs in the BM group were higher than those in the SM group (P<0.05). There were no significant differences in the patch infection, seroma, hematoma, wound dehiscence, and readmission rates between the two groups (P>0.05). Conclusions SM during ventral hernia repair is better than BM on postoperative recurrence, surgical site infection, surgical site occurrence, reoperation, etc., and could reduce medical costs. In the future, it is tried to use more SM in patients with complicated ventral hernia such as cleaning pollution and contaminated environment.

Citation： LI Yunfeng, YU Yongjiang, YU Kun, SUN Binjie, JIANG Weirong. Risk and benefit evaluations of biological versus synthetic mesh for ventral hernia repair: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 910-918. doi: 10.7507/1007-9424.202109064 Copy

1.	唐健雄. 重视腹壁疝规范化治疗. 中国实用外科杂志, 2014, 34(5): 381-383.
2.	Oma E, Bisgaard T, Jorgensen LN, et al. Nationwide propensity-score matched study of mesh versus suture repair of primary ventral hernias in women with a subsequent pregnancy. World J Surg, 2019, 43(6): 1497-1504.
3.	Emile SH, Elgendy H, Sakr A, et al. Outcomes following repair of incarcerated and strangulated ventral hernias with or without synthetic mesh. World J Emerg Surg, 2017, 12: 31. doi: 10.1186/s13017-017-0143-4.
4.	Nguyen MT, Berger RL, Hicks SC, et al. Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg, 2014, 149(5): 415-421.
5.	Darehzereshki A, Goldfarb M, Zehetner J, et al. Biologic versus nonbiologic mesh in ventral hernia repair: a systematic review and meta-analysis. World J Surg, 2014, 38(1): 40-50.
6.	Huerta S, Varshney A, Patel PM, et al. Biological mesh implants for abdominal hernia repair: US food and drug administration approval process and systematic review of its efficacy. JAMA Surg, 2016, 151(4): 374-381.
7.	Primus FE, Harris HW. A critical review of biologic mesh use in ventral hernia repairs under contaminated conditions. Hernia, 2013, 17(1): 21-30.
8.	Köckerling F, Alam NN, Antoniou SA, et al. What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia, 2018, 22(2): 249-269.
9.	Atema JJ, de Vries FE, Boermeester MA. Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects. Am J Surg, 2016, 212(5): 982-995.
10.	薛意恒, 孟岩, 孙少川, 等. 脱细胞基质材料生物补片在腹腔镜切口疝修补术中的应用研究. 中华疝和腹壁外科杂志(电子版), 2021, 15(2): 154-157.
11.	Shao JM, Ayuso SA, Deerenberg EB, et al. Biologic mesh is non-inferior to synthetic mesh in CDC class 1 & 2 open abdominal wall reconstruction. Am J Surg, 2022, 223(2): 375-379.
12.	Olavarria OA, Bernardi K, Dhanani NH, et al. Synthetic versus biologic mesh for complex open ventral hernia repair: a pilot randomized controlled trial. Surg Infect (Larchmt), 2021, 22(5): 496-503.
13.	Miserez M, Lefering R, Famiglietti F, et al. Synthetic versus biological mesh in laparoscopic and open ventral hernia repair (lapsis): results of a multinational, randomized, controlled, and double-blind trial. Ann Surg, 2021, 273(1): 57-65.
14.	Herrero A, Gonot Gaschard M, Bouyabrine H, et al. Comparative study of biological versus synthetic prostheses in the treatment of ventral hernias classified as grade Ⅱ/Ⅲ by the Ventral Hernia Working Group. J Visc Surg, 2022, 159(2): 98-107.
15.	Harris HW, Primus F, Young C, et al. Preventing recurrence in clean and contaminated hernias using biologic versus synthetic mesh in ventral hernia repair: the price randomized clinical trial. Ann Surg, 2021, 273(4): 648-655.
16.	Warren J, Desai SS, Boswell ND, et al. Safety and efficacy of synthetic mesh for ventral hernia repair in a contaminated field. J Am Coll Surg, 2020, 230(4): 405-413.
17.	de Vries FEE, Hodgkinson JD, Claessen JJM, et al. Long-term outcomes after contaminated complex abdominal wall reconstruction. Hernia, 2020, 24(3): 459-468.
18.	Nissen AT, Henn D, Moshrefi S, et al. Health-related quality of life after ventral hernia repair with biologic and synthetic mesh. Ann Plast Surg, 2019, 82(5S Suppl 4): S332-S338. doi: 10.1097/SAP.0000000000001768.
19.	Mayfield CK, Gould DJ, Wong A, et al. Value improvement and resource utilization in complex abdominal wall reconstruction. Am Surg, 2019, 85(10): 1113-1117.
20.	戴伟钢, 陈志辉, 谭进富, 等. 猪小肠黏膜下层脱细胞基质补片与聚丙烯补片应用于前腹壁切口疝修补术的疗效分析. 中华消化外科杂志, 2018, 17(11): 1095-1100.
21.	Koscielny A, Widenmayer S, May T, et al. Comparison of biological and alloplastic meshes in ventral incisional hernia repair. Langenbecks Arch Surg, 2018, 403(2): 255-263.
22.	Rampado S, Geron A, Pirozzolo G, et al. Cost analysis of incisional hernia repair with synthetic mesh and biological mesh: an Italian study. Updates Surg, 2017, 69(3): 375-381.
23.	Chamieh J, Tan WH, Ramirez R, et al. Synthetic versus biologic mesh in single-stage repair of complex abdominal wall defects in a contaminated field. Surg Infect (Larchmt), 2017, 18(2): 112-118.
24.	Totten CF, Davenport DL, Ward ND, et al. Cost of ventral hernia repair using biologic or synthetic mesh. J Surg Res, 2016, 203(2): 459-465.
25.	Sandvall BK, Suver DW, Said HK, et al. Comparison of synthetic and biologic mesh in ventral hernia repair using components separation technique. Ann Plast Surg, 2016, 76(6): 674-679.
26.	Majumder A, Winder JS, Wen Y, et al. Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surgery, 2016, 160(4): 828-838.
27.	Brescia A, Tomassini F, Berardi G, et al. Post-incisional ventral hernia repair in patients undergoing chemotherapy: improving outcomes with biological mesh. World J Surg Oncol, 2016, 14(1): 257. doi: 10.1186/s12957-016-1011-5.
28.	Bondre IL, Holihan JL, Askenasy EP, et al. Suture, synthetic, or biologic in contaminated ventral hernia repair. J Surg Res, 2016, 200(2): 488-494.
29.	Liang MK, Berger RL, Nguyen MT, et al. Outcomes with porcine acellular dermal matrix versus synthetic mesh and suture in complicated open ventral hernia repair. Surg Infect (Larchmt), 2014, 15(5): 506-512.
30.	Fischer JP, Basta MN, Mirzabeigi MN, et al. A comparison of outcomes and cost in VHWG grade Ⅱ hernias between Rives-Stoppa synthetic mesh hernia repair versus underlay biologic mesh repair. Hernia, 2014, 18(6): 781-789.
31.	El-Gazzaz G, Erem HH, Aytac E, et al. Risk of infection and hernia recurrence for patients undergoing ventral hernia repair with non-absorbable or biological mesh during open bowel procedures. Tech Coloproctol, 2013, 17(3): 315-320.
32.	Cavallo JA, Criss C, Poulose BK, et al. A multicenter prospective observational cohort study of permanent synthetic mesh versus biologic mesh reinforcement for open ventral hernia repair in clean-contaminated and contaminated surgical sites. J Am Coll Surg, 2013, 217(3): S25. doi: 10.1016/j.jamcollsurg.2013.07.041.
33.	Brewer MB, Rada EM, Milburn ML, et al. Human acellular dermal matrix for ventral hernia repair reduces morbidity in transplant patients. Hernia, 2011, 15(2): 141-145.
34.	López-Cano M, Quiles MT, Pereira JA, et al. Complex abdominal wall hernia repair in contaminated surgical fields: factors affecting the choice of prosthesis. Am Surg, 2017, 83(6): 583-590.
35.	Ghazi B, Deigni O, Yezhelyev M, et al. Current options in the management of complex abdominal wall defects. Ann Plast Surg, 2011, 66(5): 488-492.
36.	Kamarajah SK, Chapman SJ, Glasbey J, et al. Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure. BJS Open, 2018, 2(6): 371-380.
37.	Köhler G, Weitzendorfer M, Kalcher V, et al. Synthetic mesh repair for incisional hernia treatment in high-risk patients for surgical site occurrences. Am Surg, 2015, 81(4): 387-394.
38.	Birolini C, de Miranda JS, Tanaka EY, et al. The use of synthetic mesh in contaminated and infected abdominal wall repairs: challenging the dogma—A long-term prospective clinical trial. Hernia, 2020, 24(2): 307-323.
39.	Burger JW, Luijendijk RW, Hop WC, et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg, 2004, 240(4): 578-583.
40.	Samson DJ, Gachabayov M, Latifi R. Biologic mesh in surgery: a comprehensive review and meta-analysis of selected outcomes in 51 studies and 6 079 patients. World J Surg, 2021, 45(12): 3524-3540.
41.	Madani A, Niculiseanu P, Marini W, et al. Biologic mesh for repair of ventral hernias in contaminated fields: long-term clinical and patient-reported outcomes. Surg Endosc, 2017, 31(2): 861-871.
42.	Carbonell AM, Criss CN, Cobb WS, et al. Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg, 2013, 217(6): 991-998.
43.	顾岩, 杨建军, 宋致成, 等. 腹壁疝组织结构分离技术的进展和改革. 临床外科杂志, 2019, 27(9): 739-742.
44.	Holihan JL, Nguyen DH, Nguyen MT, et al. Mesh location in open ventral hernia repair: a systematic review and network meta-analysis. World J Surg, 2016, 40(1): 89-99.
45.	Borrazzo EC, Belmont MF, Boffa D, et al. Effect of prosthetic material on adhesion formation after laparoscopic ventral hernia repair in a porcine model. Hernia, 2004, 8(2): 108-112.
46.	Bendavid R, Lou W, Grischkan D, et al. A mechanism of mesh-related post-herniorrhaphy neuralgia. Hernia, 2016, 20(3): 357-365.
47.	Reynolds D, Davenport DL, Korosec RL, et al. Financial implications of ventral hernia repair: a hospital cost analysis. J Gastrointest Surg, 2013, 17(1): 159-166.
48.	Fischer JP, Basta MN, Krishnan NM, et al. A cost-utility assessment of mesh selection in clean-contaminated ventral hernia repair. Plast Reconstr Surg, 2016, 137(2): 647-659.

1. 唐健雄. 重视腹壁疝规范化治疗. 中国实用外科杂志, 2014, 34(5): 381-383.
2. Oma E, Bisgaard T, Jorgensen LN, et al. Nationwide propensity-score matched study of mesh versus suture repair of primary ventral hernias in women with a subsequent pregnancy. World J Surg, 2019, 43(6): 1497-1504.
3. Emile SH, Elgendy H, Sakr A, et al. Outcomes following repair of incarcerated and strangulated ventral hernias with or without synthetic mesh. World J Emerg Surg, 2017, 12: 31. doi: 10.1186/s13017-017-0143-4.
4. Nguyen MT, Berger RL, Hicks SC, et al. Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg, 2014, 149(5): 415-421.
5. Darehzereshki A, Goldfarb M, Zehetner J, et al. Biologic versus nonbiologic mesh in ventral hernia repair: a systematic review and meta-analysis. World J Surg, 2014, 38(1): 40-50.
6. Huerta S, Varshney A, Patel PM, et al. Biological mesh implants for abdominal hernia repair: US food and drug administration approval process and systematic review of its efficacy. JAMA Surg, 2016, 151(4): 374-381.
7. Primus FE, Harris HW. A critical review of biologic mesh use in ventral hernia repairs under contaminated conditions. Hernia, 2013, 17(1): 21-30.
8. Köckerling F, Alam NN, Antoniou SA, et al. What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia, 2018, 22(2): 249-269.
9. Atema JJ, de Vries FE, Boermeester MA. Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects. Am J Surg, 2016, 212(5): 982-995.
10. 薛意恒, 孟岩, 孙少川, 等. 脱细胞基质材料生物补片在腹腔镜切口疝修补术中的应用研究. 中华疝和腹壁外科杂志(电子版), 2021, 15(2): 154-157.
11. Shao JM, Ayuso SA, Deerenberg EB, et al. Biologic mesh is non-inferior to synthetic mesh in CDC class 1 & 2 open abdominal wall reconstruction. Am J Surg, 2022, 223(2): 375-379.
12. Olavarria OA, Bernardi K, Dhanani NH, et al. Synthetic versus biologic mesh for complex open ventral hernia repair: a pilot randomized controlled trial. Surg Infect (Larchmt), 2021, 22(5): 496-503.
13. Miserez M, Lefering R, Famiglietti F, et al. Synthetic versus biological mesh in laparoscopic and open ventral hernia repair (lapsis): results of a multinational, randomized, controlled, and double-blind trial. Ann Surg, 2021, 273(1): 57-65.
14. Herrero A, Gonot Gaschard M, Bouyabrine H, et al. Comparative study of biological versus synthetic prostheses in the treatment of ventral hernias classified as grade Ⅱ/Ⅲ by the Ventral Hernia Working Group. J Visc Surg, 2022, 159(2): 98-107.
15. Harris HW, Primus F, Young C, et al. Preventing recurrence in clean and contaminated hernias using biologic versus synthetic mesh in ventral hernia repair: the price randomized clinical trial. Ann Surg, 2021, 273(4): 648-655.
16. Warren J, Desai SS, Boswell ND, et al. Safety and efficacy of synthetic mesh for ventral hernia repair in a contaminated field. J Am Coll Surg, 2020, 230(4): 405-413.
17. de Vries FEE, Hodgkinson JD, Claessen JJM, et al. Long-term outcomes after contaminated complex abdominal wall reconstruction. Hernia, 2020, 24(3): 459-468.
18. Nissen AT, Henn D, Moshrefi S, et al. Health-related quality of life after ventral hernia repair with biologic and synthetic mesh. Ann Plast Surg, 2019, 82(5S Suppl 4): S332-S338. doi: 10.1097/SAP.0000000000001768.
19. Mayfield CK, Gould DJ, Wong A, et al. Value improvement and resource utilization in complex abdominal wall reconstruction. Am Surg, 2019, 85(10): 1113-1117.
20. 戴伟钢, 陈志辉, 谭进富, 等. 猪小肠黏膜下层脱细胞基质补片与聚丙烯补片应用于前腹壁切口疝修补术的疗效分析. 中华消化外科杂志, 2018, 17(11): 1095-1100.
21. Koscielny A, Widenmayer S, May T, et al. Comparison of biological and alloplastic meshes in ventral incisional hernia repair. Langenbecks Arch Surg, 2018, 403(2): 255-263.
22. Rampado S, Geron A, Pirozzolo G, et al. Cost analysis of incisional hernia repair with synthetic mesh and biological mesh: an Italian study. Updates Surg, 2017, 69(3): 375-381.
23. Chamieh J, Tan WH, Ramirez R, et al. Synthetic versus biologic mesh in single-stage repair of complex abdominal wall defects in a contaminated field. Surg Infect (Larchmt), 2017, 18(2): 112-118.
24. Totten CF, Davenport DL, Ward ND, et al. Cost of ventral hernia repair using biologic or synthetic mesh. J Surg Res, 2016, 203(2): 459-465.
25. Sandvall BK, Suver DW, Said HK, et al. Comparison of synthetic and biologic mesh in ventral hernia repair using components separation technique. Ann Plast Surg, 2016, 76(6): 674-679.
26. Majumder A, Winder JS, Wen Y, et al. Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surgery, 2016, 160(4): 828-838.
27. Brescia A, Tomassini F, Berardi G, et al. Post-incisional ventral hernia repair in patients undergoing chemotherapy: improving outcomes with biological mesh. World J Surg Oncol, 2016, 14(1): 257. doi: 10.1186/s12957-016-1011-5.
28. Bondre IL, Holihan JL, Askenasy EP, et al. Suture, synthetic, or biologic in contaminated ventral hernia repair. J Surg Res, 2016, 200(2): 488-494.
29. Liang MK, Berger RL, Nguyen MT, et al. Outcomes with porcine acellular dermal matrix versus synthetic mesh and suture in complicated open ventral hernia repair. Surg Infect (Larchmt), 2014, 15(5): 506-512.
30. Fischer JP, Basta MN, Mirzabeigi MN, et al. A comparison of outcomes and cost in VHWG grade Ⅱ hernias between Rives-Stoppa synthetic mesh hernia repair versus underlay biologic mesh repair. Hernia, 2014, 18(6): 781-789.
31. El-Gazzaz G, Erem HH, Aytac E, et al. Risk of infection and hernia recurrence for patients undergoing ventral hernia repair with non-absorbable or biological mesh during open bowel procedures. Tech Coloproctol, 2013, 17(3): 315-320.
32. Cavallo JA, Criss C, Poulose BK, et al. A multicenter prospective observational cohort study of permanent synthetic mesh versus biologic mesh reinforcement for open ventral hernia repair in clean-contaminated and contaminated surgical sites. J Am Coll Surg, 2013, 217(3): S25. doi: 10.1016/j.jamcollsurg.2013.07.041.
33. Brewer MB, Rada EM, Milburn ML, et al. Human acellular dermal matrix for ventral hernia repair reduces morbidity in transplant patients. Hernia, 2011, 15(2): 141-145.
34. López-Cano M, Quiles MT, Pereira JA, et al. Complex abdominal wall hernia repair in contaminated surgical fields: factors affecting the choice of prosthesis. Am Surg, 2017, 83(6): 583-590.
35. Ghazi B, Deigni O, Yezhelyev M, et al. Current options in the management of complex abdominal wall defects. Ann Plast Surg, 2011, 66(5): 488-492.
36. Kamarajah SK, Chapman SJ, Glasbey J, et al. Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure. BJS Open, 2018, 2(6): 371-380.
37. Köhler G, Weitzendorfer M, Kalcher V, et al. Synthetic mesh repair for incisional hernia treatment in high-risk patients for surgical site occurrences. Am Surg, 2015, 81(4): 387-394.
38. Birolini C, de Miranda JS, Tanaka EY, et al. The use of synthetic mesh in contaminated and infected abdominal wall repairs: challenging the dogma—A long-term prospective clinical trial. Hernia, 2020, 24(2): 307-323.
39. Burger JW, Luijendijk RW, Hop WC, et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg, 2004, 240(4): 578-583.
40. Samson DJ, Gachabayov M, Latifi R. Biologic mesh in surgery: a comprehensive review and meta-analysis of selected outcomes in 51 studies and 6 079 patients. World J Surg, 2021, 45(12): 3524-3540.
41. Madani A, Niculiseanu P, Marini W, et al. Biologic mesh for repair of ventral hernias in contaminated fields: long-term clinical and patient-reported outcomes. Surg Endosc, 2017, 31(2): 861-871.
42. Carbonell AM, Criss CN, Cobb WS, et al. Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg, 2013, 217(6): 991-998.
43. 顾岩, 杨建军, 宋致成, 等. 腹壁疝组织结构分离技术的进展和改革. 临床外科杂志, 2019, 27(9): 739-742.
44. Holihan JL, Nguyen DH, Nguyen MT, et al. Mesh location in open ventral hernia repair: a systematic review and network meta-analysis. World J Surg, 2016, 40(1): 89-99.
45. Borrazzo EC, Belmont MF, Boffa D, et al. Effect of prosthetic material on adhesion formation after laparoscopic ventral hernia repair in a porcine model. Hernia, 2004, 8(2): 108-112.
46. Bendavid R, Lou W, Grischkan D, et al. A mechanism of mesh-related post-herniorrhaphy neuralgia. Hernia, 2016, 20(3): 357-365.
47. Reynolds D, Davenport DL, Korosec RL, et al. Financial implications of ventral hernia repair: a hospital cost analysis. J Gastrointest Surg, 2013, 17(1): 159-166.
48. Fischer JP, Basta MN, Krishnan NM, et al. A cost-utility assessment of mesh selection in clean-contaminated ventral hernia repair. Plast Reconstr Surg, 2016, 137(2): 647-659.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk and benefit evaluations of biological versus synthetic mesh for ventral hernia repair: a meta-analysis

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