Biologic grafts for ventral hernia repair.pdf

The American Journal of Surgery (2013) 205, 220-230Review Article Biologic grafts for ventral hernia repair: a systematic reviewNicholas J. Slater, B.Sc.*, Marion van der Kolk, M.D., Thijs Hendriks, Ph.D., Harry van Goor, M.D., Ph.D., Robert P. Bleichrodt, M.D., Ph.D.Department of Surgery, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The NetherlandsKEYWORDS: Ventral hernia repair; Biologic graft; Xenograft; Allograft; InfectionThe authors declare no conflicts of i * Corresponding author. Tel.: 131 0501. E-mail address: n.slater@chir.umcn. Manuscript received October 24, 20 2012 0002-9610/$ - see front matter
2013 /10.1016/j.amjsurg.20Abstract BACKGROUND: Biologic grafts hold promise of a durable repair for ventral hernias with the poten- tial for fewer complications than synthetic mesh. This systematic review was performed to evaluate the effectiveness and safety of biologic grafts for ventral hernia repair. METHODS: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for studies on biologic grafts for the repair of ventral hernias. Outcomes are presented as weighted pooled proportions. RESULTS: Twenty-five retrospective studies were included. Recurrence depended on wound class, with an overall rate of 13.8% (95% confidence interval [CI], 7.6–21.3). The recurrence rate in contam- inated/dirty repairs was 23.1% (95% CI, 11.3–37.6). Abdominal wall laxity occurred in 10.5% (95% CI, 3.7–20.3) of patients. The surgical morbidity rate was 46.3% (95% CI, 33.3–59.6). Infection occurred in 15.9% (95% CI, 9.8–23.2) of patients but only led to graft removal in 4.9% of cases. CONCLUSIONS: No randomized trials are available to properly evaluate biologic grafts for ventral hernia repair. The current evidence suggests that biologic grafts perform similarly to other surgical op- tions. Biologic grafts are associated with a high salvage rate when faced with infection.
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