Abstract：
OBJECTIVE: Use of biologic or synthetic mesh in hernia repair shifts is based on evolving evidence. Poly-4-hydroxybutyrate (P4HB) biosynthetic mesh is a potential alternative to biologic and synthetic mesh in ventral hernia repair (VHR). This meta-analysis assesses the efficacy of P4HB mesh in clean and contaminated surgical settings.
METHODS: Two authors searched literature on PubMed, reviewing titles and abstracts of all articles to determine inclusion eligibility. Post-operative data were compared via transformation method to convert the proportion of patients with the outcome of interest into a suitable quantity for random-effects synthesis using STATA software.
RESULTS: Initial search yielded 287 citations. Six studies were included and categorized on whether hernia repairs were conducted in clean (CDC class I) or contaminated cases (CDC class II-IV). The pooled proportion of surgical site infection (SSI), surgical site occurrence (SSO), hernia recurrence, total surgical complications, and reoperation were calculated in 391 clean and 81 contaminated cases. For clean vs. contaminated cases, the following pooled proportions were noted: SSI (2% (CI 0-7%) vs 9% (CI 0-025) (p = 0.03), SSO: 14% (CI 5-25%) vs 35% (CI 22-50%) (p = 0.006), hernia recurrence (8% (CI 1-19%) vs 4% (CI 0-12%) (p = 0.769); surgical complications (17% (CI 6-32%) vs 50% (CI 27-72%) (p = 0.009). Reoperation data were available in 298 clean cases across four studies: 5% (CI 0-15%).
CONCLUSIONS: P4HB biosynthetic mesh may be more effective than previously thought, particularly in clean wounds. P4HB may also be superior to biologic mesh when compared to clinical trial data. Further research is necessary for more direct comparison.
METHODS: Two authors searched literature on PubMed, reviewing titles and abstracts of all articles to determine inclusion eligibility. Post-operative data were compared via transformation method to convert the proportion of patients with the outcome of interest into a suitable quantity for random-effects synthesis using STATA software.
RESULTS: Initial search yielded 287 citations. Six studies were included and categorized on whether hernia repairs were conducted in clean (CDC class I) or contaminated cases (CDC class II-IV). The pooled proportion of surgical site infection (SSI), surgical site occurrence (SSO), hernia recurrence, total surgical complications, and reoperation were calculated in 391 clean and 81 contaminated cases. For clean vs. contaminated cases, the following pooled proportions were noted: SSI (2% (CI 0-7%) vs 9% (CI 0-025) (p = 0.03), SSO: 14% (CI 5-25%) vs 35% (CI 22-50%) (p = 0.006), hernia recurrence (8% (CI 1-19%) vs 4% (CI 0-12%) (p = 0.769); surgical complications (17% (CI 6-32%) vs 50% (CI 27-72%) (p = 0.009). Reoperation data were available in 298 clean cases across four studies: 5% (CI 0-15%).
CONCLUSIONS: P4HB biosynthetic mesh may be more effective than previously thought, particularly in clean wounds. P4HB may also be superior to biologic mesh when compared to clinical trial data. Further research is necessary for more direct comparison.
摘要：
目的：在疝修补术中使用生物或合成网片是基于不断发展的证据。聚4-羟基丁酸酯（P4HB）生物合成网片是腹侧疝修补术（VHR）中生物和合成网片的潜在替代品。这项荟萃分析评估了P4HB网片在清洁和污染的手术环境中的疗效。
方法：两位作者搜索了PubMed上的文献，审查所有文章的标题和摘要，以确定纳入资格。通过转换方法比较术后数据，以使用STATA软件将具有感兴趣结果的患者比例转换为合适的数量，以进行随机效应合成。
结果：初步搜索产生287个引用。纳入了六项研究，并对是否在清洁（CDCI类）或污染病例（CDCII-IV类）中进行了疝气修复进行了分类。手术部位感染（SSI）的合并比例，手术部位发生（SSO），疝气复发,总手术并发症，计算了391例清洁和81例污染病例的再手术。对于干净的vs.污染病例,注意到以下合并比例：SSI（2%（CI0-7%）对9%（CI0-025）（p=0.03），SSO：14%（CI5-25%）对35%（CI22-50%）（p=0.006），疝复发（8％（CI1-19％）对4％（CI0-12％）（p=0.769）；手术并发症（17％（CI6-32％）对50％（CI27-72％）（p=0.009）。在4项研究中，298例清洁病例的再手术数据为5%(CI0-15%)。
结论：P4HB生物合成网可能比以前认为的更有效，特别是干净的伤口。与临床试验数据相比，P4HB也可能优于生物网格。为了更直接的比较，需要进一步的研究。
方法：两位作者搜索了PubMed上的文献，审查所有文章的标题和摘要，以确定纳入资格。通过转换方法比较术后数据，以使用STATA软件将具有感兴趣结果的患者比例转换为合适的数量，以进行随机效应合成。
结果：初步搜索产生287个引用。纳入了六项研究，并对是否在清洁（CDCI类）或污染病例（CDCII-IV类）中进行了疝气修复进行了分类。手术部位感染（SSI）的合并比例，手术部位发生（SSO），疝气复发,总手术并发症，计算了391例清洁和81例污染病例的再手术。对于干净的vs.污染病例,注意到以下合并比例：SSI（2%（CI0-7%）对9%（CI0-025）（p=0.03），SSO：14%（CI5-25%）对35%（CI22-50%）（p=0.006），疝复发（8％（CI1-19％）对4％（CI0-12％）（p=0.769）；手术并发症（17％（CI6-32％）对50％（CI27-72％）（p=0.009）。在4项研究中，298例清洁病例的再手术数据为5%(CI0-15%)。
结论：P4HB生物合成网可能比以前认为的更有效，特别是干净的伤口。与临床试验数据相比，P4HB也可能优于生物网格。为了更直接的比较，需要进一步的研究。
