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

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World Journal of Surgery Aims and scope Submit manuscript

Abstract

Aim

To compare the efficacy and safety of synthetic and biological meshes in ventral hernia repair (VHR) and abdominal wall reconstruction (AWR).

Methods

We screened all clinical trials that reported the application of synthetic and biological meshes in VHR and AWR using Medline, Web of Science, and Embase (Ovid). Only comparative studies with similar baselines such as age, sex, body mass index, degree of wound contamination, and hernia defects between the intervention and control groups were included. Effect sizes with 95% confidence were pooled using a random- or fixed-effects model based on the size of heterogeneity. A sensitivity analysis was performed to test the stability of the results.

Results

Ten studies with 1305 participants were included. Biological meshes were associated with significantly higher recurrence rate (OR, 2.09; 95% CI 1.42–3.08; I2 = 50%), surgical site infection (OR, 1.47; 95% CI 1.10–1.97; I2 = 30%), higher re-admission rate (OR, 1.51; 95% CI 1.05–2.17; I2 = 50%), and longer length of hospital stay (SMD, 0.37; 95% CI 0.10–0.65; I2 = 72%). Similar surgical site occurrence, re-operation rate, and mesh explantation rate were observed among biological and synthetic meshes. Biological meshes have no difference in recurrence rate as compared to synthetic meshes, between the clean-contaminated, and contamination-infected fields (OR, 1.41; 95% CI 0.41–4.87 vs 3.00; 95% CI 1.07–8.46; P = 0.36).

Conclusion

Synthetic meshes are a safe alternative to biological meshes for VHR and AWR. Considering the high cost of biological meshes, synthetic meshes are more appropriate for the VHR and AWR.

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Data availability

Not applicable. No datasets were generated during the production of this work.

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Acknowledgements

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Funding

This work is supported by the National Natural Science Foundation of China (Number: 81970455, 82170526).

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Author notes

  1. Hekai Shi and Rui Wang are contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan’an Road, Jing’an District, Shanghai, 200040, People’s Republic of China

    Hekai Shi, Rui Wang, Wenpei Dong, Dongchao Yang, Heng Song & Yan Gu

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  1. Hekai Shi
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Correspondence to Yan Gu.

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Shi, H., Wang, R., Dong, W. et al. Synthetic Versus Biological Mesh in Ventral Hernia Repair and Abdominal Wall Reconstruction: A Systematic Review and Recommendations from Evidence-Based Medicine. World J Surg 47, 2416–2424 (2023). https://doi.org/10.1007/s00268-023-07067-5

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