Biologic grafts for ventral hernia repair: a systematic review

Department of Surgery, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: .
American journal of surgery (Impact Factor: 2.41). 11/2012; 205(2). DOI: 10.1016/j.amjsurg.2012.05.028
Source: PubMed

ABSTRACT BACKGROUND: Biologic grafts hold promise of a durable repair for ventral hernias with the potential for fewer complications than synthetic mesh. This systematic review was performed to evaluate the effectiveness and safety of biologic grafts for ventral hernia repair. METHODS: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for studies on biologic grafts for the repair of ventral hernias. Outcomes are presented as weighted pooled proportions. RESULTS: Twenty-five retrospective studies were included. Recurrence depended on wound class, with an overall rate of 13.8% (95% confidence interval [CI], 7.6-21.3). The recurrence rate in contaminated/dirty repairs was 23.1% (95% CI, 11.3-37.6). Abdominal wall laxity occurred in 10.5% (95% CI, 3.7-20.3) of patients. The surgical morbidity rate was 46.3% (95% CI, 33.3-59.6). Infection occurred in 15.9% (95% CI, 9.8-23.2) of patients but only led to graft removal in 4.9% of cases. CONCLUSIONS: No randomized trials are available to properly evaluate biologic grafts for ventral hernia repair. The current evidence suggests that biologic grafts perform similarly to other surgical options. Biologic grafts are associated with a high salvage rate when faced with infection.


Available from: Thijs Hendriks, Jun 14, 2015
1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hernia formation after surgical procedures continues to be an important cause of surgical morbidity. Incisional reinforcement at the time of the initial operation has been used in some patient populations to reduce the risk of subsequent hernia formation. In this article, reinforcement techniques in different surgical wounds are examined to identify situations in which hernia formation may be prevented. Mesh use for midline closure, pelvic floor reconstruction, and stoma site reinforcement is discussed. Additionally, the use of retention sutures, closure of the open abdomen, and reinforcement after component separation are examined using current literature. Although existing studies do not support the routine use of mesh reinforcement for all surgical incisions, certain patient populations appear to benefit from reinforcement with lower rates of subsequent hernia formation. The identification and characterization of these groups will guide the future use of mesh reinforcement in surgical incisions.
    Clinics in Colon and Rectal Surgery 12/2014; 27(4):149-155. DOI:10.1055/s-0034-1394088
  • [Show abstract] [Hide abstract]
    ABSTRACT: Repair of hernia typically makes use of a prosthetic material; synthetic or biologic in nature. Any material which enters the body is subject to interrogation by the inflammation and immune system in addition to numerous other cell families, the outcome of which ultimately determines the success of the repair. In this review, we discuss the fundamental biology which occurs in situ when a biomaterial associates with a tissue, compare and contrast the techniques available to predict this in vitro, and review how features of hernia repair materials specifically may manipulate tissue interrogation and integration. Finally, we conclude our article by examining how biocompatibility impacts surgical practise and how a better understanding of the manner by which materials and tissues interact could benefit hernia repair.
    Hernia 09/2014; 19(2). DOI:10.1007/s10029-014-1307-8 · 2.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Prophylactic incisional negative pressure wound therapy (NPWT) use after ventral hernia repairs (VHR) remains controversial. We assessed the impact of a modified NPWT system (Hybrid-VAC) on outcomes of open VHR. Methods A 5-year retrospective analysis of all VHRs performed by a single surgeon at a single institution compared outcomes after Hybrid-VAC versus standard wound dressings (SWD). Multivariable logistic regression compared surgical site infections (SSI), surgical site occurrences (SSO), morbidity, and reoperation rates. Results We evaluated 199 patients (115 Hybrid-VAC vs. 84 SWD patients). Mean follow up was 9 months. The Hybrid-VAC cohort had lower SSI (9% vs. 32%, p<0.001) and SSO (17% vs. 42%, p=0.001) rates. Rates of major morbidity (19% vs. 31%, p=0.04) and 90-day reoperation (5% vs. 14%, p=0.02) were lower in the Hybrid-VAC cohort. Conclusions The Hybrid-VAC system is associated with optimized outcomes following open VHR. Prospective studies should validate these findings and define the economic implications of this intervention.
    The American Journal of Surgery 08/2014; 209(2). DOI:10.1016/j.amjsurg.2014.06.022 · 2.41 Impact Factor