Optimization of abdominal wall reconstruction in patients with complex hernia after oncologic surgery: comparative analysis of surgical techniques and prosthetic materials - a systematic review

Zeus Adrian Daniel Alfonso Gonzalez Mercado; Mauricio Zuluaga Zuluaga; Santiago Zuluaga Muriel; María Alejandra Puello Gómez; Simón Ali Ruiz Soto; Edison Renato Pereira Aranda; Nicolás Largacha Duque; Juan Diego Angulo Arriola; Wendy Johana Jacome Mendoza; Melany Nicoll Verdezoto Michuy

doi:10.18203/2320-6012.ijrms20251451

Authors

Zeus Adrian Daniel Alfonso Gonzalez Mercado Department of Surgery, Instituto Mexicano del Seguro Social, Mexico
Mauricio Zuluaga Zuluaga Department of General Surgery, Universidad del Valle, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia; Clínica de Occidente, Valle del Cauca, Colombia; Clínica Sebastián de Belalcazar Colsanitas, Cali, Colombia
Santiago Zuluaga Muriel Department of Medicine, Universidad Nacional de Colombia, Colombia
María Alejandra Puello Gómez Medical Department, Universidad a distancia de Madrid, Colombia
Simón Ali Ruiz Soto Department of Surgery, Complejo Asistencial Padre Las Casas, Chile
Edison Renato Pereira Aranda Department of Surgery, Complejo Asistencial Padre Las Casas, Chile
Nicolás Largacha Duque Medical Department, Universidad Libre Seccional Cali, Colombia
Juan Diego Angulo Arriola Medical Department, Universidad el Bosque, Colombia
Wendy Johana Jacome Mendoza Medical Department, Colombia
Melany Nicoll Verdezoto Michuy Medical Department, Universidad Católica Santiago De Guayaquil, Ecuador

DOI:

https://doi.org/10.18203/2320-6012.ijrms20251451

Keywords:

Abdominal wall reconstruction, Complex hernia, Oncologic surgery, Prosthetic mesh, Surgical techniques

Abstract

Abdominal wall reconstruction (AWR) following oncologic resection presents unique surgical challenges, particularly in patients with complex hernias characterized by large defects, contamination, prior mesh infections, or loss of domain. These reconstructions demand techniques that ensure durable structural integrity, minimize recurrence, and accommodate high-risk postoperative environments. A comprehensive literature search was conducted using PRISMA guidelines, including 14 primary studies and 2 systematic reviews published between 2020 and 2025. Studies included adult oncologic patients undergoing AWR with various techniques, prosthetic materials, and perioperative protocols. Risk of bias was assessed using JBI, ROBINS-I, and RoB 2 tools. The reviewed studies demonstrate that the transversus abdominis release (TAR) technique significantly reduces hernia recurrence (2.5% TAR versus 22.5% ACS, p<0.001) and wound complications. Robotic-assisted repairs resulted in reduced pain and hospital stays but incurred longer operative times and higher costs. Biologic meshes were favoured in contaminated fields but showed higher recurrence and cost compared to synthetics. Combined synthetic-biologic approaches in sarcoma patients yielded 0% recurrence with acceptable morbidity. ERAS protocols consistently reduced hospital length of stay and hernia rates (ERAS: 10.1% versus non-ERAS: 28.8%, p=0.008). Sarcopenia and hypoalbuminemia emerged as key predictors of poor surgical outcomes. Optimal AWR in oncologic patients with complex hernias requires individualized strategies that incorporate advanced surgical techniques, judicious mesh selection, and standardized perioperative care. TAR, prophylactic mesh placement, and ERAS protocols show the most promise in improving long-term outcomes. Further randomized trials are warranted to strengthen evidence for best practices.

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