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Systemic inflammatory response after hernia repair: a systematic review

  • Systematic Reviews and Meta-analyses
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

All surgical procedures elicit a complex systemic inflammatory response effectuated and modulated by cytokines. The purpose of this systematic review was to present an overview of the inflammatory response and the serum markers associated with hernia repair and to compare the response between patients treated with and without mesh.

Methods

The review was conducted in line with PRISMA guidelines. The outcomes of interest were serum concentration of leukocytes, cytokines, and acute phase proteins before and after hernia repair with or without mesh reinforcement. The risk of bias was assessed using the Cochrane ROBINS-I tool for non-randomized studies of intervention.

Results

A total of 31 studies were included in the systematic review including 1326 patients with a mean age ranging from 33 to 67 years. The studies predominantly included males (95.0% males, 5.0% female) with inguinal hernias (98.5% inguinal hernias, 1.5% incisional hernias). The inflammatory response after hernia repair was characterized by an increase in CRP, IL-6, leukocytes, neutrophils, IL-1, IL-10, fibrinogen, and α1-antitrypsin and a decrease in lymphocytes and albumin within the first 24 postoperative hours. The systemic inflammatory response was normalized before or on the seventh postoperative day. A higher CRP and IL-6 serum concentration was found in patients treated with mesh compared with sutured repairs.

Conclusions

Hernia repair elicits a systemic inflammatory response characterized by an increase in CRP, IL-6, leukocytes, neutrophils, IL-1, IL-10, fibrinogen, and α1-antitrypsin and a decrease in lymphocytes and albumin. A higher inflammatory response was found after mesh repair compared with non-mesh repair and after open mesh repair compared with laparoscopic mesh repair.

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Authors and Affiliations

  1. Center for Surgical Science, Department of Surgery, Zealand University Hospital and Copenhagen University, Lykkebækvej 1, 4600, Køge, Denmark

    Dunja Kokotovic, Jakob Burcharth, Frederik Helgstrand & Ismail Gögenur

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  1. Dunja Kokotovic
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Contributions

Study conception and design: DK, JB, FH, IG. Acquisition of data: DK, JB. Analysis and interpretation of data: DK, JB. Drafting of manuscript: DK. Critical revision of manuscript: DK, JB, FH, IG.

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Correspondence to Dunja Kokotovic.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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The authors declare that the have no conflict of interest.

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Kokotovic, D., Burcharth, J., Helgstrand, F. et al. Systemic inflammatory response after hernia repair: a systematic review. Langenbecks Arch Surg 402, 1023–1037 (2017). https://doi.org/10.1007/s00423-017-1618-1

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