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: 2.29). 11/2012; 205(2). DOI: 10.1016/j.amjsurg.2012.05.028
Source: PubMed


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.

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.

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.

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.

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    • "Although a retrospective study assessing single-stage ventral hernia repairs with lightweight polypropylene mesh implants in clean-contaminated and contaminated cases has shown some favorable results, re-operation was 12% and the incidence of surgical site occurrences (surgical site infection, wound dehiscence, or wound breakdown) was 30% [14]. A systematic review of several retrospective studies utilizing biologic grafts showed an overall recurrence rate of 13.8%, which increased to 23.1% in contaminated/dirty repairs [15]. Biologic tissue matrices are commonly used in contaminated or infected surgical fields for one-stage repair with little to no subsequent graft removal, but hernia recurrence over a 5-year period may be greater than 50% [16]. "
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    ABSTRACT: Introduction Biologic grafts have been shown to support tissue regeneration in various animal models. Very few reports in the literature exist to show tissue remodeling in patients after placement of a biologic graft. Case presentation We report the case of a 69-year-old Caucasian man with a history of small bowel carcinoid resection and concurrent recurrent ventral hernia repair with component separation and underlay biologic graft placement who underwent re-operation for metastatic carcinoid tumor to his liver. Complete incorporation of the biologic graft was observed. Tissue analysis of the incised midline fascia revealed tissue remodeling at the site of the previous abdominal wall defect. Conclusion Placement of a biologic graft in ventral hernia repair supports tissue regeneration similar to that previously reported in animal models.
    Full-text · Article · Jul 2014 · Journal of Medical Case Reports
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    • "Recently, additional experimental [14] and clinical evidence [15] has appeared supporting the use of large-pore synthetic mesh in contaminated surgical fields. Slater and coworkers [16] carried out an extensive review of clinical trials of biological matrices and synthetic mesh. They concluded that: ‘In view of the current evidence, biologic grafts have similar results to synthetic mesh or autologous repair in either clean, contaminated, or complicated ventral hernia repair’. "
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    ABSTRACT: Introduction Synthetic mesh has been used traditionally to repair abdominal wall defects, but its use is limited in the case of bacterial contamination. New biological materials are now being used successfully for delayed primary closure of contaminated abdominal wall defects. The costs of biological materials may prevent surgeons from using them. We compared the conventional staged repair of contaminated abdominal wall defects with a single-stage procedure using a non-crosslinked porcine acellular dermal matrix. Methods A total of 14 cases with Grade 3 contaminated abdominal wall defects underwent delayed primary closure of the abdomen using a non-crosslinked porcine acellular dermal matrix (Strattice™ Reconstructive Tissue Matrix, LifeCell Corp., Branchburg, NJ, USA). The results were compared with a group of 14 patients who had received conventional treatment for the repair of contaminated abdominal wall defects comprising a staged repair during two separate hospital admissions employing synthetic mesh. Treatment modalities, outcomes, and costs were compared. Results In all cases treated with delayed primary closure employing non-crosslinked porcine acellular dermal matrix, there were no complications related to its use. Two patients died due to unrelated events. Although treatment costs were estimated to be similar in the two groups, the patients treated with porcine acellular dermal matrix spent less time as an inpatient than those receiving conventional two-stage repair. Conclusions Delayed primary closure of contaminated abdominal wall defects using a non-crosslinked porcine acellular dermal matrix may be a suitable alternative to conventional staged repair. In our patients, it resulted in early restoration of abdominal wall function and shorter hospitalization. The costs for treating contaminated abdominal wall defects using porcine acellular dermal matrix during a single hospital admission were not higher than costs for conventional two-stage repair. Further randomized studies are needed to expand upon these findings.
    Full-text · Article · Jul 2014 · Journal of Medical Case Reports
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