Metanalysis of Controlled Studies Comparing Biologic and Synthetic Unabsorbable Mesh in Contaminated Fields

Abstract

Abstract In 2019, approximately U$9.7 billion were invested in abdominal wall surgery in the United States. Additionally, opting for a biological mesh can increase the cost by more than $8,000 per surgery when compared to a polypropylene mesh. Knowing that, we conducted a meta-analysis evaluating controlled studies comparing biological and synthetic unabsorbable implanted on contaminated environments, with the primary outcome being Surgical Site Infection (SSI) and assessing other outcomes such as hernia recurrence, rehospitalization or reoperation, mesh removal, and hospitalization length of stay. Our systematic search was conducted on PubMed, EMBASE, and Cochrane in accordance with the PRSIMA guidelines, searching for controlled studies comparing the use of biologic mesh against synthetic polypropylene mesh in patients with Center of Disease Control infected site classification (CDC) class II or higher. We found 1036 studies, 20 were selected for full text review and 9 were included of comparative analysis of outcomes. Our analysis indicated a higher risk of SSI development in patients with biological mesh compared to synthetic mesh (P < 0.00001) and higher risk of hernia recurrence (P < 0.0001). Also, we did not observe apparently benefit for the biological mesh group in terms of reoperation (P = 0.54) or mesh removal (P = 0.92). Patients that were submitted to biological mesh implant had higher hospital length of stay (P = 0.004) and higher occurrence of intrabdominal infection (P = 0.05). Hence, we did not observe superiority in the use of biological mesh in contaminated environments concerning key post-operative complications. Moreover, the use of synthetic polypropylene mesh reduces the incidence of hernia recurrence with a lower risk SSI.