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Published on: September 11, 2021
Synthetic vs. biologic mesh for abdominal wall reconstruction in contaminated surgical fields. A meta-analysis of
Maximos Frountzas1, Despoina Kanata2, Eirini Solia2
1First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Vas. Sofias Ave. 114, 11527, Athens, Greece. froumax@hotmail.com.
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.
Insights
Synthetic mesh offers lower recurrence rates for abdominal wall reconstruction in contaminated fields compared to biologic mesh. Both mesh types show similar surgical site infection rates, with synthetic mesh associated with shorter hospital stays.
Area of Science:
- Surgical Innovation
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Biologic meshes were historically preferred for abdominal wall reconstruction (AWR) in contaminated surgical settings.
- Concerns regarding cost and efficacy have led to the implementation of synthetic meshes.
- A comparative analysis is crucial to guide clinical decision-making.
Purpose of the Study:
- To compare the recurrence rates and postoperative outcomes of synthetic versus biologic meshes in AWR.
- To evaluate the effectiveness of synthetic meshes as an alternative to biologic meshes in contaminated surgical fields.
Main Methods:
- A systematic meta-analysis adhering to PRISMA guidelines.
- Inclusion of randomized clinical trials (RCTs) and observational studies comparing synthetic and biologic meshes for AWR in contaminated fields.
- Data synthesis using random-effects models to calculate pooled odds ratios and mean differences.
Main Results:
- Eleven studies involving 1,945 patients were analyzed.
- Synthetic meshes demonstrated significantly lower recurrence rates compared to biologic meshes in RCT subgroup analysis (p < 0.0001).
- No significant differences were observed in surgical site infection (SSI) rates; synthetic mesh use was linked to shorter hospital stays, while other outcomes were comparable.
Conclusions:
- Synthetic mesh is a safe and effective alternative to biologic mesh for AWR in contaminated surgical fields.
- Further research into the cost-effectiveness of biosynthetic meshes is warranted for similar applications.
