Frountzas Maximos, Kanata Despoina, Solia Eirini, Smerdi Dimitra, Nikolaou Christina, Chamzin Alexandros, Linardoutsos Dimitrios, Theodorou Dimitrios, Toutouzas Konstantinos G, Chatzimavroudis Grigorios, Schizas Dimitrios
First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Vas. Sofias Ave. 114, 11527, Athens, Greece.
Department of Plastic and Reconstructive Surgery, Gennimatas General Hospital, Athens, Greece.
Hernia. 2024 Dec 12;29(1):43. doi: 10.1007/s10029-024-03239-x.
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.
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.
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.
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.
生物补片曾是污染手术区域腹壁重建（AWR）的首选。然而，由于成本增加和有效性存疑，合成补片也开始被应用。本荟萃分析的目的是比较合成补片和生物补片在复发率和术后结果方面的差异。
本荟萃分析按照PRISMA指南进行设计。从数据库建立至2024年9月，检索了Medline、Scopus、EMBASE、Clinicaltrials.gov、谷歌学术和Cochrane CENTRAL。纳入比较在污染手术区域使用生物补片和合成补片进行AWR的随机临床试验（RCT）和观察性研究。由两位经验丰富的研究人员以预定义的电子表格形式提取数据。使用随机效应模型计算合并比值比（OR）和均值差（MD）。纳入的RCT使用偏倚风险2（RoB2）工具进行评估，非随机试验使用非随机试验中的偏倚风险（RoBINS-I）工具进行评估。
共纳入11项研究，涉及1945例患者。RCT的亚组分析表明，与生物补片相比，合成补片的复发率显著更低（p < 0.0001），随访情况相似（p = 0.07）。然而，手术部位感染（SSI）率没有差异。尽管合成补片与住院时间缩短相关，但两组的其他术后结果（手术部位事件、补片感染、再次入院、再次手术）相似。
与生物补片相比，合成补片应被视为污染手术区域腹壁重建的一种安全有效的选择。然而，未来的研究有望探讨生物合成补片作为此类手术区域替代选择的成本效益。
