Surgical site infection in mesh repair for ventral hernia in contaminated field: A systematic review and meta-analysis
Related Experiment Video
Updated: Nov 15, 2025
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Mohamed Maatouk1, Yacine Ben Safta1, Aymen Mabrouk1
1A21 Surgery Department, Charles Nicolle Hospital, Research laboratory LR12ES01, Faculty of Medicine of Tunis/Tunis El Manar University, Tunisia.
Background:
Given the risk of surgical site infection (SSI), the use of mesh in contaminated ventral hernia repair (VHR) is not standardized and still a clinical dilemma. This meta-analysis aimed to assess whether mesh use increased the risk of SSI in patients following VHR in contaminated field.
Methods:
We performed a systematic review of published literature. Studies comparing the mesh repair and anatomic repair, the use of mesh in different Center for Disease Control and Prevention (CDC) wound classes and mesh repair with synthetic mesh or other type of meshes to treat complicated and contaminated VHR were considered for analysis. The main outcome was SSI incidence.
Results:
Six studies compared mesh and suture repairs. No significant difference in SSI incidence was observed between patients with complicated VHR in the mesh and suture repair groups.Five studies analyzed mesh repair in patients by field contamination level. There was no significant difference between the use of mesh in clean-contaminated, contaminated and dirty field versus clean wound class. Moreover, there was no significant difference between the use of mesh in clean-contaminated and contaminated cases.Four studies compared mesh repair technique with synthetic mesh or other type of meshes were included. The incidence of SSI was significantly lower in the synthetic mesh group.
Conclusions:
The use of mesh repair in the management of complicated VHR compared to suture repair is not associated with an increased incidence of SSI even in potentially contaminated fields.
Insights
Mesh use in contaminated ventral hernia repair (VHR) does not increase surgical site infection (SSI) risk. Synthetic mesh showed lower SSI incidence compared to other mesh types in VHR management.
Area of Science:
- Surgical innovation
- Hernia repair techniques
- Infection control in surgery
Background:
- The use of mesh in contaminated ventral hernia repair (VHR) presents a clinical dilemma due to the risk of surgical site infection (SSI).
- Current practices for mesh utilization in VHR within contaminated fields lack standardization.
Purpose of the Study:
- To evaluate the association between mesh use and SSI risk in patients undergoing VHR in contaminated surgical fields.
- To compare SSI rates between mesh repair and suture repair for complicated VHR.
- To assess the impact of mesh type and wound contamination level on SSI incidence.
Main Methods:
- Systematic review and meta-analysis of published literature.
- Inclusion of studies comparing mesh versus anatomic repair, mesh in different CDC wound classes, and synthetic versus other mesh types for VHR.
- Primary outcome measured was the incidence of SSI.
Main Results:
- No significant difference in SSI incidence was found between mesh and suture repair groups for complicated VHR.
- Mesh use in clean-contaminated, contaminated, and dirty fields did not result in significantly higher SSI rates compared to clean fields.
- Synthetic mesh repair was associated with a significantly lower incidence of SSI compared to other mesh types.
Conclusions:
- Mesh repair for complicated VHR is not linked to increased SSI rates, even in potentially contaminated settings.
- Synthetic mesh may offer an advantage in reducing SSI incidence in VHR.
- These findings support the consideration of mesh in VHR management across various contamination levels.
