Review
The role of biologic mesh in abdominal wall reconstruction: a systematic review of the current literature

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Abstract

Background

Biologic mesh in the form of allograft or xenograft products have been used in complicated abdominal hernia repair, but few comparative studies exist.

Methods

A systematic review of original incisional hernia studies was conducted to include 2 primary end points: hernia recurrence and surgical site occurrence. Analysis of variance and a Satterthwaite t test compared the devices.

Results

Twenty-nine studies were included in this analysis, which included 1,257 patients. The total number of studies and the total subjects for each device include the following: Permacol (Tissue Science Laboratories, Hampshire, UK) (4/64), Surgisis (Cook Medical, Bloomington, IN) (3/87), and Alloderm (LifeCell, Corp, Branchburg, NJ) (23/1,106). Device-specific recurrence rates and surgical site occurrence rates, respectively, were as follows: Alloderm (20.8%, 31.4%), Permacol (10.9%, 25%), and Surgisis (8.0%, 40.2%). A Satterthwaite t test comparison revealed significantly higher numbers of hernia recurrence (P = .006) and surgical site occurrence (P = .04) when comparing Alloderm with Permacol.

Conclusions

Biologic mesh does play a beneficial role in abdominal wall reconstruction although allograft acellular dermal matrix does have a higher recurrence rate as compared with xenograft products, which limits its current role in hernia repair.

Section snippets

Why a Systematic Review?

The use of biologic mesh in ventral hernia repair has increased dramatically since its introduction, but most of the published data on the subject exist in retrospective reviews and small case series, which are Level 4 data (Table 1). Systematic reviews are powerful tools for evidence-based medicine practice that methodically and reproducibly examine all the existing published data on a subject. They are considered higher levels of evidence than even randomized controlled trials.4 This

Methods

A systematic review was conducted in November 2010 of the PubMed/Medline databases, using 7 independent searches shown in Table 2. The search methodology used was designed to be inclusive of all possible articles, and include both generic and brand names for biological mesh products. The predetermined inclusion and exclusion criteria are listed in Table 3. The goal of the study was to examine only ventral hernias in the adult population and exclude all other types of abdominal wall–acquired

Results

The systematic review of the current literature yielded a total of 203 articles, and after application of inclusion and exclusion criteria, there were 31 total articles that qualified for the study. One study compared 2 separate devices and is counted only once in the total number of studies. Four studies were found using Permacol (cross-linked porcine acellular dermal matrix; Tissue Science Laboratories, Hampshire, UK), 3 using Surgisis (porcine small intestine submucosa; Cook Medical,

Comments

Complex abdominal wall reconstructions are being performed more frequently by the plastic surgeon secondary to the use of biologic mesh products and the necessity for component separation and soft-tissue manipulation. Acellular dermal matrix has been used since the 1970s for soft-tissue reinforcement, although it has become an accepted and reliable option for hernia repair over the past 8 years. Recent advances include the chemical treatment of the dermal product to include cross-linking and

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    The authors have no conflicts of interest.

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