title: Mesh reinforcement for the prevention of incisional hernia formation: a systematic review and meta-analysis of randomized controlled trials.
abstract: European Hernia Society guidelines suggested that the evidence of mesh augmentation for the prevention of incisional hernia (IH) was weak. In addition, previous systematic reviews seldom focused on quality of life and cost-effectiveness related to mesh placement. Therefore, an updated meta-analysis was performed to clarify quality of life, cost-effectiveness, the safety, and effectiveness of mesh reinforcement in preventing the incidence of IH.
  
  
  
  Embase, Pubmed, and the Cochrane library were searched from the inception to May 2016 without language limitation for randomized controlled trials (RCTs) which explored mesh reinforcement for the prevention of IH in patients undergoing abdominal surgeries.
  
  
  
  Twelve RCTs totaling 1661 patients (958 in mesh, 703 in nonmesh) were included in our study. Compared with nonmesh, mesh reinforcement can effectively decrease the incidence of IH (relative risk: 0.19; 95% CI: 0.09-0.42). Besides, mesh placement was associated with improved quality of life, a higher rate of seroma (relative risk: 1.64; 95% CI: 1.13-2.37), and longer operating time (mean difference: 17.62; 95% CI: 1.44-33.80). No difference can be found between both groups in postoperative overall morbidity, systemic postoperative morbidity, wound-related morbidity, surgical site infection, hematoma, wound disruption, postoperative mortality, and length of hospital stay.
  
  
  
  Prophylactic mesh reinforcement may be effective and safe to prevent the formation of IH after abdominal surgery, without impairing quality of life. Thus, preventive mesh should be routinely recommended in high-risk patients.
authors.affiliation: Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou, Gansu Province, China.
authors.forename: Xi-Chen
authors.initials: XC
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou, Gansu Province, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou, Gansu Province, China.
authors.forename: Zeng-Xi
authors.initials: ZX
authors.lastname: Yang
authors.affiliation: Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou, Gansu Province, China.
authors.forename: Jian-Xin
authors.initials: JX
authors.lastname: Gan
authors.affiliation: Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou, Gansu Province, China. Electronic address: yinlanning@163.com.
authors.forename: Lan-Ning
authors.initials: LN
authors.lastname: Yin
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D000069290:Incisional Hernia / Q000401:mortality / Q000517:prevention & control*; D007902:Length of Stay; D061646:Operative Time; D010149:Postoperative Pain; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013526:Surgical Mesh
keywords: Incisional hernia; Meta-analysis; Randomized controlled trials; Surgical mesh