Document Detail


A critical review of biologic mesh use in ventral hernia repairs under contaminated conditions.
MedLine Citation:
PMID:  23296600     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We used an evidence-based approach to determine whether the promotions and claims of superiority of biologic mesh over synthetic mesh use in ventral hernia repairs (VHRs) under contaminated conditions were sound and valid.
METHODS: We searched the Medline database to specifically identify review articles relating to biologic mesh and VHR and critically reviewed these studies using an evidence-based approach.
RESULTS: For the past 45 years, four clinical reviews and one systematic review have included biologic meshes as part of a larger discussion on available prosthetics for VHR. All reviews supported biologic mesh use, especially in the setting of contaminated fields. Yet, the primary literature included in these reviews and served as the basis for these conclusions consisted entirely of case series and case reports, which have the lowest level of evidence in determining scientific validity. Furthermore, the FDA has neither cleared nor approved this particular use.
CONCLUSIONS: The cumulative data regarding biologic mesh use in VHRs under contaminated conditions does not support the claim that it is better than synthetic mesh used under the same conditions. The highly promoted and at least moderately utilized practice of placing biologic mesh in contamination is being done outside of the original intended use, and a re-evaluation of or possible moratorium on biologic mesh use in hernia surgery is seriously warranted. Alternatively, an industry-sponsored national registry of patients in whom ventral hernia repairs involved biologic mesh would substantively add to our understanding regarding how these intriguing biomaterials are being used and their overall clinical efficacy.
Authors:
F E Primus; H W Harris
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2013-01-08
Journal Detail:
Title:  Hernia : the journal of hernias and abdominal wall surgery     Volume:  17     ISSN:  1248-9204     ISO Abbreviation:  Hernia     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-30     Completed Date:  2013-07-31     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  9715168     Medline TA:  Hernia     Country:  France    
Other Details:
Languages:  eng     Pagination:  21-30     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Bioprosthesis / utilization*
Hernia, Ventral / microbiology,  surgery*
Herniorrhaphy / adverse effects
Humans
Surgical Mesh / utilization*
Surgical Wound Infection / etiology,  prevention & control*
Grant Support
ID/Acronym/Agency:
DK07573-23/DK/NIDDK NIH HHS; R01 GM095967/GM/NIGMS NIH HHS; T32 DK007573/DK/NIDDK NIH HHS
Comments/Corrections
Comment In:
Hernia. 2013 Feb;17(1):3-11   [PMID:  23314566 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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