Köckerling F, Alam N N, Antoniou S A, Daniels I R, Famiglietti F, Fortelny R H, Heiss M M, Kallinowski F, Kyle-Leinhase I, Mayer F, Miserez M, Montgomery A, Morales-Conde S, Muysoms F, Narang S K, Petter-Puchner A, Reinpold W, Scheuerlein H, Smietanski M, Stechemesser B, Strey C, Woeste G, Smart N J
Department of Surgery and Center of Minimally Invasive Surgery, Vivantes Hospital, 13585, Berlin, Germany.
Department of General Surgery, Manchester Royal Infirmary, Manchester, UK.
Hernia. 2018 Apr;22(2):249-269. doi: 10.1007/s10029-018-1735-y. Epub 2018 Jan 31.
Although many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations.
A European working group, "BioMesh Study Group", composed of invited surgeons with a special interest in surgical meshes, formulated key questions, and forwarded them for processing in subgroups. In January 2016, a workshop was held in Berlin where the findings were presented, discussed, and voted on for consensus. Findings were set out in writing by the subgroups followed by consensus being reached. For the review, 114 studies and background analyses were used.
The cumulative data regarding biologic mesh under contaminated conditions do not support the claim that it is better than synthetic mesh. Biologic mesh use should be avoided when bridging is needed. In inguinal hernia repair biologic and biosynthetic meshes do not have a clear advantage over the synthetic meshes. For prevention of incisional or parastomal hernias, there is no evidence to support the use of biologic/biosynthetic meshes. In complex abdominal wall hernia repairs (incarcerated hernia, parastomal hernia, infected mesh, open abdomen, enterocutaneous fistula, and component separation technique), biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes.
The routine use of biologic and biosynthetic meshes cannot be recommended.
尽管许多外科医生已在复杂腹壁疝修补术中采用生物和生物合成补片，但也有其他人对这些产品的使用提出质疑。几篇综述文章针对报道生物补片用于不同腹壁修补术的研究质量不佳提出了批评。本共识性综述的目的是对生物和生物合成补片在预定义临床情况下的疗效进行循证分析。
一个欧洲工作组“生物补片研究组”，由对手术补片有特别兴趣的受邀外科医生组成，制定了关键问题，并将其转发给各子组进行处理。2016年1月，在柏林举办了一次研讨会，会上展示、讨论了研究结果并进行投票以达成共识。各子组将研究结果写成书面报告，随后达成共识。本次综述使用了114项研究和背景分析。
关于生物补片在污染条件下的累积数据并不支持其优于合成补片的说法。需要进行桥接时应避免使用生物补片。在腹股沟疝修补术中，生物和生物合成补片并不比合成补片具有明显优势。对于预防切口疝或造口旁疝，没有证据支持使用生物/生物合成补片。在复杂腹壁疝修补术（嵌顿疝、造口旁疝、补片感染、开放性腹部、肠皮肤瘘和组织分离技术）中，生物和生物合成补片并不能提供优于合成补片的选择。
不建议常规使用生物和生物合成补片。
