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Comparison of outcomes of ventral hernia repair using different meshes: a systematic review and network meta-analysis

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Abstract

Purpose

We conducted a network meta-analysis to evaluate potential differences in patient outcomes when different meshes, especially biological meshes, were used for ventral hernia repair.

Methods

PubMed, Embase, Cochrane Library, and Clinical Trials.gov databases were searched for studies comparing biological meshes with biological or synthetic meshes for ventral hernia repair. The outcomes were hernia recurrence rate, surgical site infection, and seroma. We performed a two-step network meta-analysis to investigate the outcomes of several biological meshes: non-cross-linked human acellular dermal matrix (NCHADM), non-cross-linked porcine ADM (NCPADM), non-cross-linked bovine ADM (NCBADM), cross-linked porcine ADM (CPADM), and porcine small intestinal submucosa (PSIS).

Results

From 6304 publications, 23 studies involving 2603 patients were finally included. We found no differences between meshes in recurrence at 1-year follow-up and in surgical site infection rate. NCBADM was associated with the lowest recurrence rate and the lowest surgical site infection rate. NCHADM implantation was associated with the lowest rate of seroma. PSIS was associated with a higher risk of seroma than NCHADM (pooled risk ratio 3.89, 95% confidence interval 1.13–13.39) and NCPADM (RR 3.42, 95% CI 1.29–9.06).

Conclusions

Our network meta-analysis found no differences in recurrence rate or surgical site infection among different biological meshes. The incidence of postoperative seroma was higher with PSIS than with acellular dermal matrices. We observed large heterogeneity in the studies of ventral hernia repair using biological meshes, and, therefore, well-designed randomized clinical trials are needed.

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Funding

The study was funded by National Natural Science Foundation of China (NSFC) (31771043); National defense science and technology excellence youth science fund (2019-JCJQ-ZQ-002); National Defense Science and technology foundation strengthening plan (2019-JCJQ-JJ-069).

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Authors and Affiliations

  1. The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China

    H. Zhou & Z. Zhang

  2. Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China

    Y. Shen, X. Liu & J. Chen

  3. Department of General Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China

    J. Zhang

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Contributions

HZ and ZZ did the literature search. JC and JZ formed the study design. Data collection done by HZ, XL and ZZ. HZ and XL analyzed the data. JZ and YS interpreted the data. HZ wrote the manuscript. YS, JZ and JC critically reviewed the manuscript.

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Correspondence to J. Zhang or J. Chen.

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Zhou, H., Shen, Y., Zhang, Z. et al. Comparison of outcomes of ventral hernia repair using different meshes: a systematic review and network meta-analysis. Hernia 26, 1561–1571 (2022). https://doi.org/10.1007/s10029-022-02652-4

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