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Ventral hernia repair with synthetic mesh in a contaminated field: a systematic review and meta-analysis

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Abstract

Purpose

The use of mesh in ventral hernia repair becomes especially challenging when associated with a contaminated field. Permanent synthetic mesh use in this setting is currently debated and this discussion is yet to be resolved clinically or in the literature. We aim to systematically assess postoperative outcomes of non-absorbable synthetic mesh (NASM) used in ventral hernia repair in the setting of contamination.

Methods

A literature search of PubMed, Embase, Scopus, Cinahl, and Cochrane Library identified all articles from 2000–2020 that examined the use of NASM for ventral hernia repair in a contaminated field. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Qualitative analysis was completed for all included studies using a modified Newcastle–Ottawa scale.

Results

Of 630 distinct publications and 104 requiring full review, this study included 17 articles published between 2007 and 2020. Meta-analysis demonstrated absorbable mesh was associated with more HR (OR 1.89, 1.15–3.12, p = 0.008), SSO (OR 1.43, 0.96–2.11, p = 0.087), SSI (OR 2.84, 1.85–4.35, p < 0.001), and unplanned reoperation (OR 1.99, 1.19–3.32, p = 0.009) compared to NASM.

Conclusion

The use of NASM for ventral hernia repair in a contaminated field may be a safe alternative to absorbable mesh, as evidenced by lower rates of postoperative complications. This review counters the current clinical paradigm, and additional prospective randomized controlled trials are warranted.

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Availability of data and material

All data and materials comply with field standards.

Code availability

All statistically analysis performed using STATA.

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Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA

    M. P. Morris, J. A. Mellia, A. N. Christopher, V. Patel, R. B. Broach & J. P. Fischer

  2. Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    A. N. Christopher

  3. Division of Plastic Surgery, Brown University, Providence, RI, USA

    M. N. Basta

  4. University of Pennsylvania, Philadelphia, PA, USA

    K. Qiu

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MPM, JAM, ANC, VP, and RBB. The first draft of the manuscript was written by MM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to J. P. Fischer.

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Conflict of interest

JPF has received funding and consulting fees from Becton- Dickinson, Integra, Gore and Baxter.

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 This article does not contain any studies with human participants or animals performed by any of the authors.

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This study does not include human or animal participants.

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Morris, M.P., Mellia, J.A., Christopher, A.N. et al. Ventral hernia repair with synthetic mesh in a contaminated field: a systematic review and meta-analysis. Hernia 25, 1035–1050 (2021). https://doi.org/10.1007/s10029-020-02358-5

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