title: Prophylactic mesh placement in high-risk patients undergoing elective laparotomy: a systematic review.
abstract: BACKGROUND
  Incisional hernia is a significant complication in patients undergoing elective laparotomy. Its incidence is increased in patients with risk factors, such as obesity and chronic respiratory disease. The purpose of this pooled analysis was to evaluate the use of prophylactic mesh placement following laparotomy in high-risk patients.
  
  
  METHODS
  A systematic literature search of MEDLINE, Embase, Web of Science, and Cochrane database was conducted. Outcome measures were incidence of postoperative incisional hernia, seroma, and wound infection rates.
  
  
  RESULTS
  Five randomized, controlled trials (RCTs) and four comparative studies that met the inclusion criteria were identified. In total, 464 patients who underwent laparotomy closure with mesh placement and 755 patients who underwent conventional laparotomy closure were included. A reduced incidence of incisional hernia was observed when laparotomy was combined with prophylactic mesh placement in pooled analysis of RCTs (pooled odds ratio = 0.32; 95 % confidence interval = 0.12-0.83; P = 0.02) and comparative studies (pooled odds ratio = 0.11; 95 % confidence interval = 0.04-0.33; P < 0.001) respectively. No significant differences were observed in the incidence of seroma or wound infection following prophylactic mesh placement.
  
  
  CONCLUSIONS
  The results of this pooled analysis suggest a benefit to prophylactic mesh placement during laparotomy closure in high-risk patients with a significantly reduced incidence of incisional hernia without any significant differences in seroma formation and wound infection rates. Further studies must evaluate the incidence of mesh-specific complications, including foreign body sensation and chronic pain, before strong recommendations can be made.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London and Imperial College Healthcare NHS Trust, London, UK. subra.nachiappan@doctors.org.uk
authors.forename: Subramanian
authors.initials: S
authors.lastname: Nachiappan
authors.forename: Sheraz
authors.initials: S
authors.lastname: Markar
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesaligam
authors.forename: Paul
authors.initials: P
authors.lastname: Ziprin
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
mesh_terms: D002986:Clinical Trials as Topic; D017558:Elective Surgical Procedures / Q000009:adverse effects; D006555:Hernia, Ventral / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects; D012307:Risk Factors; D013526:Surgical Mesh