title: Repair of incisional hernias with biological prosthesis: a systematic review of current evidence.
abstract: BACKGROUND
  No consensus has been reached on the use of bioprosthetics to repair abdominal wall defects. The purpose of this systematic review was to summarize the outcomes from studies describing this use of various bioprosthetics for incisional hernia repair.
  
  
  METHODS
  Studies published by October 2011 were identified through literature searches using EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials.
  
  
  RESULTS
  A total of 491 articles were scanned, 60 met eligibility criteria. Most studies were retrospective case studies. The studies ranged considerably in methodologic quality, with a modified Methodological Index of Nonrandomized Studies score from 5 to 12. Many repairs were performed in contaminated surgical sites (47.9%). At least one complication was seen in 87% of repairs. Major complications noted were wound infections (16.9%) and seroma (12.0%). With a mean follow-up period of 13.6 months the hernia recurrence rate was 15.2%.
  
  
  CONCLUSIONS
  There is an insufficient level of high-quality evidence in the literature on the value of bioprosthetics for incisional hernia repair. Randomized controlled trials that use standardized reporting comparing bioprosthetics with synthetic mesh for incisional hernia repair are needed.
authors.affiliation: Department of Surgery, Tulane University, 1430 Tulane Ave., SL-22, New Orleans, LA 70112, USA. cbellows@tulane.edu
authors.forename: Charles F
authors.initials: CF
authors.lastname: Bellows
authors.forename: Alison
authors.initials: A
authors.lastname: Smith
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malsbury
authors.forename: William Scott
authors.initials: WS
authors.lastname: Helton
mesh_terms: D058107:Abdominal Wound Closure Techniques; D001672:Biocompatible Materials; D001705:Bioprosthesis; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications
chemical_list: D001672:Biocompatible Materials