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Review
. 2018 Apr;22(2):249-269.
doi: 10.1007/s10029-018-1735-y. Epub 2018 Jan 31.

What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction?

F Köckerling  1 , N N Alam  2 , S A Antoniou  3 , I R Daniels  4 , F Famiglietti  5 , R H Fortelny  6 , M M Heiss  7 , F Kallinowski  8 , I Kyle-Leinhase  9 , F Mayer  10 , M Miserez  5 , A Montgomery  11 , S Morales-Conde  12 , F Muysoms  9 , S K Narang  4 , A Petter-Puchner  13 , W Reinpold  14 , H Scheuerlein  15 , M Smietanski  16   17 , B Stechemesser  18 , C Strey  19 , G Woeste  20 , N J Smart  4
Affiliations
Review

What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction?

F Köckerling et al. Hernia. 2018 Apr.

Abstract

Introduction: Although many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations.

Methods: A European working group, "BioMesh Study Group", composed of invited surgeons with a special interest in surgical meshes, formulated key questions, and forwarded them for processing in subgroups. In January 2016, a workshop was held in Berlin where the findings were presented, discussed, and voted on for consensus. Findings were set out in writing by the subgroups followed by consensus being reached. For the review, 114 studies and background analyses were used.

Results: The cumulative data regarding biologic mesh under contaminated conditions do not support the claim that it is better than synthetic mesh. Biologic mesh use should be avoided when bridging is needed. In inguinal hernia repair biologic and biosynthetic meshes do not have a clear advantage over the synthetic meshes. For prevention of incisional or parastomal hernias, there is no evidence to support the use of biologic/biosynthetic meshes. In complex abdominal wall hernia repairs (incarcerated hernia, parastomal hernia, infected mesh, open abdomen, enterocutaneous fistula, and component separation technique), biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes.

Conclusion: The routine use of biologic and biosynthetic meshes cannot be recommended.

Keywords: Biologic meshes; Biosynthetic meshes; Bridging; Complex ventral hernias; Contaminated surgical field.

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Conflict of interest statement

Conflict of interest

NNA, SAA, FF, MMH, FKA, IK, FM, SKN, AP, WR, HS, and BS declare no conflict of interest. NS declares conflict of interest directly related to the submitted work. IRD, RHF, MM, AM, SM, FM, MS, CS, and GW declare conflict of interest not directly related to the submitted work. FK declares conflict of interest directly and not directly related to the submitted work.

Ethical approval

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

Human and animal rights

This article does not contain any study with animals performed by any of the authors.

Informed consent

For this type of article informed consent is not required.

References

    1. FitzGerald JF, Kumar AS. Biologic versus synthetic mesh reinforcement: what are the pros and cons? Clin Colon Rectal Surg. 2014;27:140–148. doi: 10.1055/s-0034-1394155. - DOI - PMC - PubMed
    1. Atema JJ, de Vries FEE, Boermeester MA. Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects. Am J Surg. 2016;212:982–995. doi: 10.1016/j.amjsurg.2016.05.003. - DOI - PubMed
    1. Cross W, Kumar A, Kowdley GC. Biological mesh in contaminated fields—overuse without data: a systematic review of their use in abdominal wall reconstruction. Am Surg. 2014;80:3–8. - PubMed
    1. Huerta S, Varshney A, Patel PM, Mayo HG, Livingston EH. Biological mesh implants for abdominal hernia repair—US food and drug adminstration approval process and systematic review of its efficacy. JAMA Surg. 2016 - PubMed
    1. Hiles M, Ritchie RDR, Altizer AM. Are biologic grafts effective for hernia repair? Surg Innov. 2009;16(1):26–37. doi: 10.1177/1553350609331397. - DOI - PubMed

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