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Use of a Rat Model to Study Ventral Abdominal Hernia Repair
Published on: October 2, 2017
Biological mesh in contaminated fields--overuse without data: a systematic review of their use in abdominal wall
Wirt Cross1, Ajay Kumar, Gopal Chandru Kowdley
1Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland, USA.
Abstract:
Ventral hernia repair in contaminated fields is a significant problem for surgeons. We performed a systematic review regarding the use of biological mesh in contaminated fields for abdominal wall reconstruction. The primary end points were recurrence and infection of the hernia repair. An independent search of scientific papers in the English language was performed by three reviewers. Articles were chosen based on reference to ventral hernias, their use in infected fields, and in human subjects. Papers were scored using the Methodological Index for Non-Randomized Studies and those with a score of 8 or more were combined to evaluate the end points. A total of 16 studies from six different mesh products met our criteria. These papers comprised 554 patients with an overall infection rate of 24 per cent and a recurrence rate of 20 per cent. The largest study used 116 patients. All papers were case series. Overall the data for use of biological mesh products in contaminated fields are limited. Further controlled studies are needed to address this important and clinically relevant question. Caution should be used when using biological mesh products in infected fields because there is a paucity of controlled data and none have U.S. Food and Drug Administration approval for use in infected fields.
Insights
Using biological mesh for ventral hernia repair in contaminated fields shows high recurrence (20%) and infection (24%) rates. Limited data necessitates caution and further controlled studies for abdominal wall reconstruction.
Area of Science:
- Surgical Innovation
- Biomaterials in Medicine
- Abdominal Wall Reconstruction
Background:
- Ventral hernia repair in contaminated surgical fields presents significant challenges.
- Biological mesh is increasingly considered for abdominal wall reconstruction in these complex cases.
- Current evidence regarding its efficacy and safety in infected fields is limited.
Purpose of the Study:
- To systematically review the use of biological mesh in contaminated fields for ventral hernia repair.
- To evaluate the primary end points of recurrence and infection rates associated with biological mesh use.
- To assess the overall quality of evidence for biological mesh in abdominal wall reconstruction.
Main Methods:
- A systematic literature search was independently conducted by three reviewers.
- Included studies focused on ventral hernias, use in infected fields, and human subjects.
- Papers were assessed using the Methodological Index for Non-Randomized Studies (MINORS) with a threshold of 8 or higher.
Main Results:
- 16 studies involving 554 patients and six different biological mesh products met the inclusion criteria.
- The overall infection rate was 24%, and the recurrence rate was 20%.
- All included studies were case series, indicating limited controlled data.
Conclusions:
- Data on biological mesh use in contaminated fields for ventral hernia repair are limited.
- Caution is advised due to the paucity of controlled data and lack of FDA approval for infected fields.
- Further controlled studies are essential to establish the safety and efficacy of biological mesh in these challenging surgical scenarios.
