title: Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects.
abstract: BACKGROUND
  Repair 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.
  
  
  METHODS
  Thirty-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.
  
  
  CONCLUSIONS
  Analysis 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.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.j.atema@amc.uva.nl.
authors.forename: Jasper J
authors.initials: JJ
authors.lastname: Atema
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Fleur E E
authors.initials: FE
authors.lastname: de Vries
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D034861:Abdominal Wall / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery; D001688:Biological Products / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
chemical_list: D001688:Biological Products
keywords: Abdominal wall defect; Contaminated/contamination; Ventral hernia