Abstract
Millions of abdominal wall repair procedures are performed each year for primary and incisional hernias both in the European Union and in the United States with extremely high costs. Synthetic meshes approved for augmenting abdominal wall repair provide adequate mechanical support but have significant drawbacks (seroma formation, adhesion to viscera, stiffness of abdominal wall, and infection). Biologic scaffolds (i.e., derived from naturally occurring materials) represent an alternative to synthetic surgical meshes and are less sensitive to infection. Among biologic scaffolds, extracellular matrix scaffolds promote stem/progenitor cell recruitment in models of tissue remodeling and, in the specific application of abdominal wall repair, have enough mechanical strength to support the repair. However, many concerns remain about the use of these scaffolds in the clinic due to their higher cost of production compared with synthetic meshes, despite having the same recurrence rate. The present review aims to highlight the pros and cons of using biologic scaffolds as surgical devices for abdominal wall repair and present possible improvements to widen their use in clinical practice.
Highlights
Surgery for hernia repair represents the most common type of abdominal wall procedure performed today
For both ventral and incisional hernia repairs are estimated at more than $10 billion/year, which is a cost that will increase over time because of increasing patient age and a consequential higher frequency of comorbidities and adverse events [5,6]
Polyester mesh coated with an absorbable layer of oxidized collagen and chitosan, facing the peritoneum, applied in a full-thickness abdominal wall repair in rabbits, led to the lowest incidence of seroma formation when compared to both synthetic mesh and other composite meshes
Summary
Surgery for hernia repair represents the most common type of abdominal wall procedure performed today. There many advantages, including a milder immune response, a decreased incidence of fistulae, and are some concerns with the use of biological materials such as their supposedly inferior mechanical reduced fibrosis. We highlight the pros and cons of the use of supposedly inferior mechanical strength and higher cost of production. We highlight biological meshes in abdominal wall repair, as determined in both pre-clinical and clinical studies. This the pros and cons of the use of biological meshes in abdominal wall repair, as determined in both review does not consider synthetic meshes in detail, as they are extensively described elsewhere [9,10,11].
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