The role of biologic mesh in abdominal wall reconstruction: a systematic review of the current literature

BackgroundBiologic mesh in the form of allograft or xenograft products have been used in complicated abdominal hernia repair, but few comparative studies exist.MethodsA systematic review of original incisional hernia studies was conducted to include 2 primary end points: hernia recurrence and surgical site occurrence. Analysis of variance and a Satterthwaite t test compared the devices.ResultsTwenty-nine studies were included in this analysis, which included 1,257 patients. The total number of studies and the total subjects for each device include the following: Permacol (Tissue Science Laboratories, Hampshire, UK) (4/64), Surgisis (Cook Medical, Bloomington, IN) (3/87), and Alloderm (LifeCell, Corp, Branchburg, NJ) (23/1,106). Device-specific recurrence rates and surgical site occurrence rates, respectively, were as follows: Alloderm (20.8%, 31.4%), Permacol (10.9%, 25%), and Surgisis (8.0%, 40.2%). A Satterthwaite t test comparison revealed significantly higher numbers of hernia recurrence (P = .006) and surgical site occurrence (P = .04) when comparing Alloderm with Permacol.ConclusionsBiologic mesh does play a beneficial role in abdominal wall reconstruction although allograft acellular dermal matrix does have a higher recurrence rate as compared with xenograft products, which limits its current role in hernia repair.