Abstract
Although recently published guidelines recommend against the use of synthetic non-absorbable materials in cases of potentially contaminated or contaminated surgical fields due to the increased risk of infection (1, 2), the use of bio-prosthetic meshes for abdominal wall or ventral hernia repair is still controversially discussed in such cases. Bio-prosthetic meshes have been recommended due to less susceptibility for infection and the decreased risk of subsequent mesh explantation. The purpose of this review is to elucidate if there are any indications for the use of biological and biosynthetic meshes in incarcerated abdominal wall hernias based on the recently published literature. A literature search of the Medline database using the PubMed search engine, using the keywords returned 486 articles up to June 2015. The full text of 486 articles was assessed and 13 relevant papers were identified including 5 retrospective case cohort studies, 2 case-controlled studies, and 6 case series. The results of Franklin et al. (3-5) included the highest number of biological mesh repairs (Surgisis(®)) by laparoscopic IPOM in infected fields, which demonstrated a very low incidence of infection and recurrence (0.7 and 5.2%). Han et al. (6) reported in his retrospective study, the highest number of treated patients due to incarcerated hernias by open approach using acellular dermal matrix (ADM(®)) with very low rate of infection as well as recurrences (1.6 and 15.9%). Both studies achieved acceptable outcome in a follow-up of at least 3.5 years compared to the use of synthetic mesh in this high-risk population (7). Currently, there is a very limited evidence for the use of biological and biosynthetic meshes in strangulated hernias in either open or laparo-endoscopic repair. Finally, there is an urgent need to start with randomized controlled comparative trials as well as to support registries with data to achieve more knowledge for tailored indication for the use of biological meshes.
Highlights
The BioMesh Study Group has set itself the task of identifying the best way to use biological meshes for various indications
Titles and abstracts were searched for the use of biologic meshes in open and laparoendoscopic repair of incarcerated/strangulated abdominal wall hernias
In the special case of an incarcerated recurrent Amyand’s hernia, the only paper concerning the use of a biological mesh was published by Quartey et al (16)
Summary
The BioMesh Study Group has set itself the task of identifying the best way to use biological meshes for various indications. The first step (toward achieving that goal) is to compile systematic reviews of different indications on the basis of the existing literature. The available literature sources will be evaluated in accordance with the Oxford Centre for Evidence-based Medicine-Levels of Evidence (March 2009). Based on the review findings, corresponding Statements and Recommendations are to be formulated in a Consensus Conference for the use of biological meshes regarding different indications. The findings of the Consensus Conference will be summarized as a joint publication. This present publication is part of the project undertaken by the BioMesh Study Group
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