Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, Texas.
Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
J Surg Res. 2023 Nov;291:603-610. doi: 10.1016/j.jss.2023.07.003. Epub 2023 Aug 3.
Synthetic mesh is widely utilized for clean ventral hernia repair; however, it is unclear if synthetic mesh provides the same benefits with high-risk patients or during contaminated cases. Many surgeons use biologic mesh in these settings, but there is little evidence to support this practice. Our objective was to compare the clinical outcomes of utilizing biologic mesh versus synthetic mesh during ventral hernia repair.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a review of the literature was conducted using Cochrane library, EMBASE, Clinicaltrials.gov, and PubMed for randomized controlled trials published that compared biologic versus synthetic mesh during ventral hernia repair. The primary outcome was major complications defined as deep or organ space surgical site infection, reoperations, and hernia recurrences.
Of 1889 manuscripts screened, four publications were included. The four studies included a total of 758 patients, with 381 receiving biologic mesh and 377 receiving synthetic mesh. Compared to biologic mesh, synthetic mesh had lower rates of major complications (38.6% versus 23.4, risk ratio = 0.55, 95% confidence interval = 0.35 to 0.86, P = 0.009) and hernia recurrence (24.5 % versus 10.3%, risk ratio = 0.44, 95% confidence interval = 0.28 to 0.69, P = 0.004). In addition, there was a lower percentage of surgical site infection and reoperation in the synthetic mesh group.
Contrary to current surgical teaching, placement of permanent synthetic mesh into a contaminated field yielded rates of complications that were comparable or reduced compared to biologic mesh.
合成网片广泛应用于清洁腹壁疝修补术；然而，对于高危患者或污染情况下，合成网片是否具有相同的益处尚不清楚。许多外科医生在这些情况下使用生物补片，但支持这种做法的证据很少。我们的目的是比较在腹壁疝修补术中使用生物补片与合成补片的临床结果。
根据系统评价和荟萃分析的首选报告项目指南，使用 Cochrane 图书馆、EMBASE、Clinicaltrials.gov 和 PubMed 对已发表的比较生物补片与合成补片在腹壁疝修补术中应用的随机对照试验进行文献回顾。主要结局为严重并发症，定义为深部或器官间隙手术部位感染、再次手术和疝复发。
在筛选出的 1889 篇文献中，有 4 篇文献被纳入。这四项研究共纳入 758 例患者，其中 381 例接受生物补片，377 例接受合成补片。与生物补片相比，合成补片的严重并发症发生率较低（38.6%比 23.4%，风险比为 0.55，95%置信区间为 0.35 至 0.86，P=0.009）和疝复发率较低（24.5%比 10.3%，风险比为 0.44，95%置信区间为 0.28 至 0.69，P=0.004）。此外，合成补片组的手术部位感染和再次手术的比例较低。
与目前的外科教学相反，将永久性合成网片置于污染区域的并发症发生率与生物补片相当或降低。
