Meta-analysis of primary mesh augmentation as prophylactic measure to prevent incisional hernia.
BACKGROUND
Incisional hernia (IH) remains one of the most frequent postoperative complications after abdominal surgery. As a consequence, primary mesh augmentation (PMA), a technique to strengthen the abdominal wall, has been gaining popularity. This meta-analysis was conducted to evaluate the prophylactic effect of PMA on the incidence of IH compared to primary suture (PS).


METHODS
A meta-analysis was conducted according to the PRISMA guidelines. Randomized controlled trials (RCTs) comparing PMA and PS for closing the abdominal wall after surgery were included.


RESULTS
Out of 576 papers, 5 RCTs were selected comprising 346 patients. IH occurred significantly less in the PMA group (RR 0.25, 95% CI 0.12-0.52, I(2)0%; p < 0.001). No difference could be observed with regard to wound infection (RR 0.86, 95% CI 0.39-1.91, I(2) 0%; p = 0.71) or seroma (RR 1.22, 95% CI 0.64-2.33, I(2) 0%; p = 0.55). A trend was observed for chronic pain in favor of the PS group (RR 5.95, 95% CI 0.74-48.03, I(2)0%; p = 0.09).


CONCLUSIONS
The use of PMA for abdominal wall closure is associated with significantly lower incidence of IH compared to PS.
Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Lucas
L
Timmermans
Barry
B
de Goede
Hasan H
HH
Eker
Bob J H
BJ
van Kempen
Johannes
J
Jeekel
Johan F
JF
Lange
D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D006555:Hernia, Ventral / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000379:methods; D009765:Obesity / Q000453:epidemiology; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013526:Surgical Mesh / Q000706:statistics & numerical data*; D013536:Suture Techniques