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A novel tool to evaluate bias in literature on use of biologic mesh in abdominal wall hernia repair

  • J. Con
  • L. Zarain
  • S. GognaEmail author
  • D. J. Samson
  • K. Prabhakaran
  • S. Gashi
  • E. Tilley
  • R. Latifi



Biologic meshes are being increasingly used for abdominal hernia repair in high-risk patients or patients with a previous history of wound infection, due to their infection-resistant properties. Several studies have been carried out to assess whether biologic mesh is superior to synthetic mesh, as well as to establish guidelines for their use. Unfortunately, most of these studies were not rigorously designed and were vulnerable to different types of bias. The systematic reviews that have been published so far on this topic contain the same biases and limitations of the primary articles that are analyzed. The lack of a literature review on the bias on the use of biological mesh prompted us to conduct the literature search, assessment and plan this article.


We performed a literature search in PubMed, Embase and Cochrane databases of systematic reviews on biologic mesh for ventral hernia repair. The literature review was conducted using the Population, Intervention, Comparisons, Outcomes and Design approach. We identified 40 studies that matched the stringent criteria we had set. We then created a 13-point instrument to assess for bias and applied it on the primary studies that we intended to analyze.


Most primary studies are case series or case reports of patients undergoing abdominal hernia repair with biologic mesh, without any comparison group, and the inclusion of cases was only specified to be consecutive in 6 out of 40 cases. In terms of assessing outcomes, in none of the 40 articles were the outcome assessors blinded to the intervention or exposure status of participants.


The instrument that we created could allow to assess the risk of bias in different kind of studies. Our assessment of the studies based on the criteria that we had set up in the instrument clearly identified that further research needs to be done due to the lack of unbiased studies regarding the use of biologic meshes for abdominal hernia repair.


Biological mesh Abdominal wall hernia Bias Assessment Literature 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

Human and animal rights

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

Informed consent



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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryWestchester Medical CenterValhallaUSA
  2. 2.Department of Surgery, Westchester Medical CenterNew York Medical CollegeValhallaUSA
  3. 3.Department of Surgery, Clinical Research UnitWestchester Medical CenterValhallaUSA
  4. 4.Section of Acute Care Surgery, Department of Surgery, Westchester Medical CenterNew York Medical CollegeValhallaUSA
  5. 5.Department of Surgery, Clinical Research UnitWestchester Medical CenterValhallaUSA
  6. 6.Department of Surgery, Clinical Research UnitWestchester Medical CenterValhallaUSA

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