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Meta-analysis of randomised trials comparing the use of prophylactic mesh to standard midline closure in the reduction of incisional herniae

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Abstract

Purpose Incisional hernia (IH) is common complication following laparotomy. Research suggests that the use of a prophylactic mesh can reduce the rate of IH. We performed an updated meta-analysis to better understand the evidence regarding prevention of IH using prophylactic mesh.

Methods

PubMed, clinictrials.gov.uk, and the Cochrane database were searched for randomised controlled trials comparing closure of the abdomen after laparotomy using a prophylactic mesh with suture closure. A meta-analysis was then performed. The primary outcome was the occurrence of IH.

Results

Eight studies were identified for inclusion in the meta-analysis with a total of 727 patients.

Primary outcome

There was a significant reduction in the occurrence of IH in the mesh group vs. the suture repair group, OR 0.14 (95% CI 0.07–0.27).

Secondary outcomes

There was a significant increase in the number of seromas in the mesh group vs. the suture repair group, OR 1.73 (95% CI 1.04–2.87). There was also a significant increase in operative time in the mesh group vs. the suture repair group SMD 0.24 (95% CI 0.00–0.48).

Conclusions

This meta-analysis found a reduction in the occurrence of IH after a laparotomy when a prophylactic mesh is used versus a suture repair. The majority of patients included in the studies were deemed to be at high risk of IH. There appears to be sufficient evidence to recommend the use of a prophylactic mesh during laparotomy in high-risk patients.

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References

  1. Bosanquet DC, Ansell J, Abdelrahman T et al (2015) Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS One. doi:10.1371/journal.pone.0138745

    PubMed  PubMed Central  Google Scholar 

  2. Millbourn D, Cengiz Y, Israelsson LA (2009) Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 144:1056–1059. doi:10.1001/archsurg.2009.189

    Article  PubMed  Google Scholar 

  3. van Ramshorst GH, Eker HH, Hop WCJ et al (2012) Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg 204:144–150. doi:10.1016/j.amjsurg.2012.01.012

    Article  PubMed  Google Scholar 

  4. Burger JWA, Luijendijk RW, Hop WCJ et al (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–585. doi:10.1097/01.sla.0000141193.08524.e7

    PubMed  PubMed Central  Google Scholar 

  5. Diener MK, Voss S, Jensen K et al (2010) Elective midline laparotomy closure: the inline systematic review and meta-analysis. Ann Surg 251:843–856. doi:10.1097/SLA.0b013e3181d973e4

    Article  PubMed  Google Scholar 

  6. Muysoms FE, Antoniou SA, Bury K et al (2015) European hernia society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24. doi:10.1007/s10029-014-1342-5

    Article  CAS  PubMed  Google Scholar 

  7. Muysoms FE, Dietz UA (2016) Prophylactic meshes in the abdominal wall. Chir. doi:10.1007/s00104-016-0229-7

    Google Scholar 

  8. Muysoms FE, Detry O, Vierendeels T et al (2016) Prevention of incisional hernias by prophylactic mesh-augmented reinforcement of midline laparotomies for abdominal aortic aneurysm treatment: a randomized controlled trial. Ann Surg 263:638–645. doi:10.1097/SLA.0000000000001369

    Article  PubMed  Google Scholar 

  9. Wang X-C, Zhang D, Yang Z-X et al (2017) Mesh reinforcement for the prevention of incisional hernia formation: a systematic review and meta-analysis of randomized controlled trials. J Surg Res 209:17–29. doi:10.1016/j.jss.2016.09.055

    Article  PubMed  Google Scholar 

  10. Borab ZM, Shakir S, Lanni MA et al (2017) Does prophylactic mesh placement in elective, midline laparotomy reduce the incidence of incisional hernia? A systematic review and meta-analysis. Surgery 161:1149–1163. doi:10.1016/j.surg.2016.09.036

    Article  PubMed  Google Scholar 

  11. Timmermans L, de Goede B, Eker HH et al (2013) Meta-analysis of primary mesh augmentation as prophylactic measure to prevent incisional hernia. Dig Surg 30:401–409. doi:10.1159/000355956

    Article  PubMed  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012. doi:10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

  13. Table 8.5.a: the Cochrane Collaboration tool for assessing risk of bias. http://handbook.cochrane.org/chapter_8/table_8_5_a_the_cochrane_collaborations_tool_for_assessing.htm. Accessed 29 Sep 2016

  14. Review Manager (RevMan) (2014) [Computer program] Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration

  15. Bevis PM, Windhaber RAJ, Lear PA et al (2010) Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. Br J Surg 97:1497–1502. doi:10.1002/bjs.7137

    Article  CAS  PubMed  Google Scholar 

  16. Abo-Ryia MH, El-Khadrawy OH, Abd-Allah HS (2013) Prophylactic preperitoneal mesh placement in open bariatric surgery: a guard against incisional hernia development. Obes Surg 23:1571–1574. doi:10.1007/s11695-013-0915-1

    Article  PubMed  Google Scholar 

  17. Strzelczyk JM, Szymański D, Nowicki ME et al (2006) Randomized clinical trial of postoperative hernia prophylaxis in open bariatric surgery. Br J Surg 93:1347–1350. doi:10.1002/bjs.5512

    Article  CAS  PubMed  Google Scholar 

  18. El-Khadrawy OH, Moussa G, Mansour O, Hashish MS (2009) Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients. Hernia 13:267–274. doi:10.1007/s10029-009-0484-3

    Article  CAS  PubMed  Google Scholar 

  19. de la Peña CG, Achirica CM, Domínguez-Adame E, Díez JM (2003) Primary closure of laparotomies with high risk of incisional hernia using prosthetic material: analysis of usefulness. Hernia 7:134–136. doi:10.1007/s10029-003-0124-2

    Article  Google Scholar 

  20. Caro-Tarrago A, Casas CO, Salido AJ et al (2014) Prevention of incisional hernia in midline laparotomy with an onlay mesh: a randomized clinical trial. World J Surg 38:2223–2230. doi:10.1007/s00268-014-2510-6

    Article  CAS  PubMed  Google Scholar 

  21. García-Ureña MÁ, López-Monclús J, Hernando LAB et al (2015) Randomized controlled trial of the use of a large-pore polypropylene mesh to prevent incisional hernia in colorectal surgery. Ann Surg 261:876–881. doi:10.1097/SLA.0000000000001116

    Article  PubMed  Google Scholar 

  22. Höer J, Lawong G, Klinge U, Schumpelick V (2002) Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chir 73:474–480. doi:10.1007/s00104-002-0425-5

    Article  Google Scholar 

  23. Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71. doi:10.1002/bjs.1800720127

    Article  CAS  PubMed  Google Scholar 

  24. Langbach O, Bukholm I, Benth JŠ, Røkke O (2016) Long-term quality of life and functionality after ventral hernia mesh repair. Surg Endosc. doi:10.1007/s00464-016-4850-9

    PubMed  Google Scholar 

  25. den Hartog D, Dur AHM, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 3:CD006438. doi:10.1002/14651858.CD006438.pub2

    Google Scholar 

  26. Muysoms FE, Jairam A, López-Cano M et al (2016) Prevention of incisional hernias with biological mesh: a systematic review of the literature. Front Surg 3:53. doi:10.3389/fsurg.2016.00053

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bessa SS, Abdel-fattah MR, Al-Sayes IA, Korayem IT (2015) Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated groin hernias: a 10-year study. Hernia 19:909–914. doi:10.1007/s10029-015-1360-y

    Article  CAS  PubMed  Google Scholar 

  28. Deerenberg EB, Harlaar JJ, Steyerberg EW et al (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. The Lancet 386:1254–1260. doi:10.1016/S0140-6736(15)60459-7

    Article  Google Scholar 

  29. Fischer JP, Basta MN, Wink JD et al (2015) Cost-utility analysis of the use of prophylactic mesh augmentation compared with primary fascial suture repair in patients at high risk for incisional hernia. Surgery 158:700–711. doi:10.1016/j.surg.2015.02.030

    Article  PubMed  Google Scholar 

  30. Fischer JP, Basta MN, Mirzabeigi MN et al (2016) A risk model and cost analysis of incisional hernia after elective, abdominal surgery based upon 12,373 cases. Ann Surg 263:1010–1017. doi:10.1097/SLA.0000000000001394

    Article  PubMed  PubMed Central  Google Scholar 

  31. Basta MN, Mirzabeigi MN, Shubinets V et al (2016) Predicting incisional hernia after bariatric surgery: a risk stratification model based upon 2161 operations. Surg Obes Relat Dis 12:1466–1473. doi:10.1016/j.soard.2016.03.022

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK

    R. Payne & S. Ward

  2. James Paget University Hospital, Gorleston, UK

    J. Aldwinckle

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  1. R. Payne
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  2. J. Aldwinckle
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  3. S. Ward
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Correspondence to R. Payne.

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R. Payne, J. Aldwinckle, and S. Ward declare that they have no conflict of interest.

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Payne, R., Aldwinckle, J. & Ward, S. Meta-analysis of randomised trials comparing the use of prophylactic mesh to standard midline closure in the reduction of incisional herniae. Hernia 21, 843–853 (2017). https://doi.org/10.1007/s10029-017-1653-4

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  • DOI: https://doi.org/10.1007/s10029-017-1653-4

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