ReviewSystematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects

- Repair of potentially contaminated abdominal wall defects using biologic or synthetic mesh results in comparable surgical site complication and a hernia recurrence rates.
- Biologic repair of contaminated defects results in considerable higher rates of surgical site complications and a hernia recurrence rate of 30%.
- No benefit of biologic mesh over synthetic mesh could be demonstrated for potentially contaminated defects. For contaminated defects, lack of reports on synthetic mesh repair hamper surgical decision making.

BackgroundRepair of contaminated abdominal wall defects entails the dilemma of choosing between synthetic material, with its presumed risk of surgical site complications, and biologic material, a costly alternative with questionable durability.Data sourcesThirty-two studies published between January 1990 and June 2015 on repair of (potentially) contaminated hernias with ≥25 patients were reviewed. Fifteen studies solely described hernia repair with biologic mesh, 6 nonabsorbable synthetic meshes, and 11 described various techniques. Surgical site complications and hernia recurrence rates were evaluated per degree of contamination and mesh type by calculating pooled proportions.ConclusionsAnalysis showed no benefit of biologic over synthetic mesh for repair of potentially contaminated hernias with comparable surgical site complication rates and a hernia recurrence rate of 9% for biologic and 9% for synthetic repair. Biologic mesh repair of contaminated defects showed considerable higher rates of surgical site complications and a hernia recurrence rate of 30%. As only 1 study on synthetic repair of contaminated hernias was available, surgical decision making in the approach of contaminated abdominal wall defects is hampered.