Carvalho Alvaro Cota, Santos Fernando Augusto V, De Carvalho Garcia Diego Paim
General Surgery at Hospital Felício Rocho, Belo Horizonte, MG, Brazil.
Surgical Oncology at Biocor - D'or, Belo Horizonte, MG, Brazil.
Surg Endosc. 2025 Jun 5. doi: 10.1007/s00464-025-11811-4.
In 2019, approximately U$9.7 billion were invested in abdominal wall surgery in the United States. Opting for a biological mesh can increase the cost by more than $8000 per surgery when compared to a polypropylene mesh.
This meta-analysis evaluated controlled studies comparing biological and synthetic mesh in contaminated environments with the primary outcome being Surgical Site Infection (SSI) and assessing other outcomes such as hernia recurrence, re-admission or reoperation, mesh removal, surgical site occurrence, hospitalization length of stay. The systematic search was conducted in PubMed, EMBASE, and Cochrane databases in accordance with the PRSIMA guidelines, searching for controlled studies comparing the use of biologic mesh against synthetic polypropylene mesh in patients with center of disease control infected site classification (CDC) class II or higher.
1036 studies were found and 19 were selected for full-text review and 8 were included in the comparative analysis of outcomes. The systematic analysis indicated a higher risk of SSI development in patients with biological mesh compared to synthetic mesh (P = 0.03) with high heterogeneity with and higher risk of hernia recurrence (P < 0.0001). Also, no apparent benefit was found for the biological mesh group in terms of reoperation (P = 0.54) or mesh removal (P = 0.96), nor regarding surgical site occurrence (hematoma P = 0. 51; seroma P = 0.57) or intra-abdominal infection (P = 0.31).
This study found no evidence of superiority for biological meshes over synthetic meshes in CDC Class II to IV contaminated environments regarding major postoperative complications following abdominal reconstruction.
2019年，美国在腹壁手术方面的投资约为97亿美元。与聚丙烯网片相比，选择生物网片每次手术的成本可能会增加8000多美元。
本荟萃分析评估了在污染环境中比较生物网片和合成网片的对照研究，主要结局为手术部位感染（SSI），并评估其他结局，如疝复发、再次入院或再次手术、网片取出、手术部位情况、住院时间。根据PRISMA指南，在PubMed、EMBASE和Cochrane数据库中进行系统检索，寻找在疾病控制中心感染部位分类（CDC）II级或更高等级患者中比较生物网片与合成聚丙烯网片使用情况的对照研究。
共检索到1036项研究，选择19项进行全文审查，8项纳入结局比较分析。系统分析表明，与合成网片相比，使用生物网片的患者发生SSI的风险更高（P = 0.03），异质性高，疝复发风险也更高（P < 0.0001）。此外，在再次手术（P = 0.54）或网片取出（P = 0.96）方面，生物网片组未发现明显益处，在手术部位情况（血肿P = 0.51；血清肿P = 0.57）或腹腔内感染（P = 0.31）方面也未发现明显益处。
本研究未发现证据表明在CDC II至IV级污染环境中，腹部重建术后主要并发症方面生物网片优于合成网片。
