Abstract
Aim
Biologic mesh has been increasingly utilized in complex ventral hernia repair despite limited evidence at low risk of bias supporting its growth. We hypothesized biologic mesh when compared to synthetic mesh would have fewer major complications at one year.
Material and Methods
We performed a participant-level meta-analysis of published randomized controlled trials (RCTs) comparing biologic to synthetic mesh at one year. Primary outcome was major complication (composite of mesh infection, recurrence, reoperation, or death) at one year post-operative. Secondary outcomes included length of index hospital stay, surgical site occurrence, and surgical site infection. Outcomes were assessed using frequentist generalized linear models.
Results
A total of 252 patients from two RCTs were included, 126 patients randomized to the intervention arm of biologic mesh and 126 patients randomized to the control of synthetic mesh. Median follow-up was 15 (12, 27) months. Major complication occurred in 41 (33%) patients randomized to biologic mesh, and 44 (35%) patients randomized to synthetic mesh, (relative risk [RR] 0.91, 95% confidence interval [CI] 0.54-1.55, p-value 0.740). There were 36 total recurrences, 23 (18%) in the biologic arm, and 13 (10%) in the synthetic arm (RR 1.83, 95% CI 0.84-3.99, p-value 0.130). The remainder of outcomes demonstrated no statistically significant differences.
Conclusions
The risk of major complication did not differ between biologic versus synthetic mesh. In patients undergoing ventral hernia repair, there was no clinical benefit with biologic mesh as opposed to synthetic mesh at one year post-operative.
Robotic versus open primary ventral hernia repair: A randomized controlled trial (Robovent Trial)