Synthetic vs. biologic mesh for abdominal wall reconstruction in contaminated surgical fields. A meta-analysis of randomized controlled trials and observational studies.

Autor: Frountzas M; First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Vas. Sofias Ave. 114, 11527, Athens, Greece. froumax@hotmail.com., Kanata D; First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Vas. Sofias Ave. 114, 11527, Athens, Greece., Solia E; First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Vas. Sofias Ave. 114, 11527, Athens, Greece., Smerdi D; First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Vas. Sofias Ave. 114, 11527, Athens, Greece., Nikolaou C; Department of Plastic and Reconstructive Surgery, Gennimatas General Hospital, Athens, Greece., Chamzin A; First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Vas. Sofias Ave. 114, 11527, Athens, Greece., Linardoutsos D; First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Vas. Sofias Ave. 114, 11527, Athens, Greece., Theodorou D; First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Vas. Sofias Ave. 114, 11527, Athens, Greece., Toutouzas KG; First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Vas. Sofias Ave. 114, 11527, Athens, Greece., Chatzimavroudis G; Second Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece., Schizas D; First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
Jazyk: angličtina
Zdroj: Hernia : the journal of hernias and abdominal wall surgery [Hernia] 2024 Dec 12; Vol. 29 (1), pp. 43. Date of Electronic Publication: 2024 Dec 12.
DOI: 10.1007/s10029-024-03239-x
Abstrakt: Purpose: Biologic meshes had been the first choice for abdominal wall reconstruction (AWR) in contaminated surgical fields. However, due to increased cost and questioned effectiveness, synthetic meshes have been also implemented. The aim of the present meta-analysis was to compare synthetic and biologic mesh in terms of recurrence and postoperative outcomes.
Methods: The present meta-analysis was designed using the PRISMA guidelines. A search in Medline, Scopus, EMBASE, Clinicaltrials.gov, Google Scholar and Cochrane CENTRAL was conducted from inception until September 2024. Randomized clinical trials (RCTs) and observational studies which compared the use of biologic and synthetic mesh for AWR in contaminated surgical fields were included. Data were extracted by two experienced researchers in pre-defined electronic forms. Pooled odds ratios (OR) and mean differences (MD) were calculated using a random-effects model. Included RCTs were assessed using the Risk of Bias 2 (RoB2) tool and non-randomized trials with the Risk of Bias in non-Randomized Trials (RoBINS-I) tool.
Results: Overall 11 studies were included which enrolled 1,945 patients. Subgroup analysis of RCTs indicated significantly lower recurrence rates for synthetic compared to biologic mesh (p < 0.0001) with a similar follow-up (p = 0.07). Nevertheless, no difference was demonstrated in surgical site infection (SSI) rates. Although synthetic mesh was associated with shorter length of stay, the other postoperative outcomes (surgical site occurrences, mesh infections, readmissions, reoperations) were similar among the two groups.
Conclusion: Synthetic mesh should be considered as a safe and effective option for abdominal wall reconstruction in contaminated surgical fields compared to biologic mesh. Nevertheless, future research is expected to investigate cost-effectiveness of biosynthetic meshes, as alternative option in such surgical fields.
Competing Interests: Declarations. Conflict of interest: The authors declare that there is no conflict of interest.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
Databáze: MEDLINE
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