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30-08-2023 | Seroma | Review

Heavyweight versus non-heavyweight mesh in ventral hernia repair: a systematic review and meta-analysis

Authors: Bruna Oliveira Trindade, Patrícia Marcolin, Gabriela R Brandao, Sarah Bueno Motter, Sérgio Mazzola Poli de Figueiredo, Rui-Min Diana Mao, Richard Lu

Published in: Hernia | Issue 2/2024

Abstract

Purpose

There is considerable variability among surgeons regarding the type of mesh used in ventral hernia repair. There has been an increasing incidence of mesh fractures with lightweight (LW) and mediumweight (MW) meshes. However, HW mesh has been associated with a greater foreign body sensation and chronic pain. This meta-analysis aims to compare the outcomes of HW and non-heavyweight (NHW) meshes in ventral hernia repair.

Methods

We systematically reviewed the PubMed, Embase, Cochrane, and Scopus databases to identify studies comparing HW with NHW meshes in hernia repair. Outcomes analyzed included hernia recurrence, seroma, hematoma, foreign body sensation, postoperative pain, and wound infection. We performed two subgroup analyses focusing on randomized controlled trials and open retromuscular repairs. Statistical analysis was performed using RevMan 5.4.

Results

We screened 1704 studies. Nine studies were finally included in this meta-analysis and comprised 3001 patients from 4 RCTs and 5 non-randomized. The majority of patients (57.1%) underwent open retromuscular repair. HW mesh was significantly associated with increased in foreign body sensation (OR 3.71; 95% CI 1.40–9.84; p = 0.008), but there was no difference in other outcomes. In RCTs analysis, there was no difference between meshes. In open retromuscular repairs, HW mesh was associated with more seromas (OR 1.48; 95% CI 1.01–2.17; p = 0.05).

Conclusion

Our study found that HW mesh was associated with more foreign body sensation. Also, open retromuscular repairs analysis showed that HW was associated with more seromas. Further randomized studies are needed to understand better the role of HW mesh in ventral hernia repair.

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Liang MK, Holihan JL, Itani K, Alawadi ZM, Gonzalez JRF, Askenasy EP, Ballecer C, Chong HS, Goldblatt MI, Greenberg JA, Harvin JA, Keith JN, Martindale RG, Orenstein S, Richmond B, Roth JS, Szotek P, Towfigh S, Tsuda S, Berger DH (2017) Ventral hernia management: expert consensus guided by systematic review. Annals Surg 265(1):80–89. https://doi.org/10.1097/SLA.0000000000001701CrossRef

Funk LM, Perry KA, Narula VK, Mikami DJ, Melvin WS (2013) Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States. Surg Endosc 27(11):4104–4112. https://doi.org/10.1007/s00464-013-3075-4CrossRefPubMed

Luijendijk RW, Hop WCJ, Van Den Tol MP, De Lange DCD, Braaksma MMJ, IJzermans JNM, Boelhouwer RU, De Vries BC, Salu MKM, Wereldsma JCJ, Bruijninckx CMA, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. New Eng J Med 343(6):392–398. https://doi.org/10.1056/NEJM200008103430603CrossRefPubMed

Cobb WS (2018) A Current review of synthetic meshes in abdominal wall reconstruction. Plastic Reconstruct Surg 142:64S-71S. https://doi.org/10.1097/PRS.0000000000004857CrossRef

Grubnik VV, Grubnik AV, Vorotyntseva KO (2014) Laparoscopic repair of incisional and ventral hernias with the new type of meshes: Randomized control trial. Videosurg Other Miniinvasive Tech 2:145–151. https://doi.org/10.5114/wiitm.2014.41623CrossRef

Amid PK (1997) Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1(1):15–21. https://doi.org/10.1007/BF02426382CrossRef

Brown CN, Finch JG (2010) Which mesh for hernia repair? Ann R Coll Surg Engl 92(4):272–278. https://doi.org/10.1308/003588410X12664192076296CrossRefPubMedPubMedCentral

Moreno-Egea A, Carrillo-Alcaraz A, Soria-Aledo V (2013) Randomized clinical trial of laparoscopic hernia repair comparing titanium-coated lightweight mesh and medium-weight composite mesh. Surg Endosc 27(1):231–239. https://doi.org/10.1007/s00464-012-2425-yCrossRefPubMed

Nguyen PT, Asarias JR, Pierce LM (2012) Influence of a new monofilament polyester mesh on inflammation and matrix remodeling. J Invest Surg 25(5):330–339. https://doi.org/10.3109/08941939.2011.639848CrossRefPubMed

10.

Lake SP, Ray S, Zihni AM, Thompson DM, Gluckstein J, Deeken CR (2015) Pore size and pore shape – but not mesh density – alter the mechanical strength of tissue ingrowth and host tissue response to synthetic mesh materials in a porcine model of ventral hernia repair. J Mech Behav Biomed Mater 42:186–197. https://doi.org/10.1016/j.jmbbm.2014.11.011CrossRefPubMed

11.

Petro CC, Nahabet EH, Criss CN, Orenstein SB, Von Recum HA, Novitsky YW, Rosen MJ (2015) Central failures of lightweight monofilament polyester mesh causing hernia recurrence: a cautionary note. Hernia 19(1):155–159. https://doi.org/10.1007/s10029-014-1237-5CrossRefPubMed

12.

Li J, Ji Z, Zhang W, Li L (2015) The comparison of lightweight mesh and standard mesh in incisional hernia repair with the open sublay technique: the results of a meta-analysis. Surg Laparoscopy, Endoscopy & Percutaneous Techniques 25(3):238–244. https://doi.org/10.1097/SLE.0000000000000144CrossRef

13.

Krpata DM, Petro CC, Prabhu AS, Tastaldi L, Zolin S, Fafaj A, Rosenblatt S, Poulose BK, Pierce RA, Warren JA, Carbonell AM, Goldblatt MI, Stewart TG, Olson MA, Rosen MJ (2021) Effect of hernia mesh weights on postoperative patient-related and clinical outcomes after open ventral hernia repair: a randomized clinical trial. JAMA Surg 156(12):1085. https://doi.org/10.1001/jamasurg.2021.4309CrossRefPubMed

14.

Kroh A, Zufacher M, Eickhoff R, Heise D, Helmedag M, Ulmer F, Neumann UP, Conze J, Hilgers R-D, Binnebösel M (2023) No difference in outcomes between large- and small-pore meshes in a prospective, randomized, multicenter trial investigating open retromuscular meshplasty for incisional hernia repair. Langenbeck’s Archives of Surgery 408(1):22. https://doi.org/10.1007/s00423-022-02751-xCrossRefPubMedPubMedCentral

15.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097CrossRefPubMedPubMedCentral

16.

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan A-W, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Higgins JP (2016) ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ. https://doi.org/10.1136/bmj.i4919CrossRefPubMedPubMedCentral

17.

Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC, Cochrane Bias Methods Group, & Cochrane Statistical Methods Group (2011) The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343(2):d5928–d5928. https://doi.org/10.1136/bmj.d5928CrossRefPubMedPubMedCentral

18.

Welty G, Klinge U, Klosterhalfen B, Kasperk R, Schumpelick V (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5(3):142–147. https://doi.org/10.1007/s100290100017CrossRefPubMed

19.

Schmidbauer S, Ladurner R, Hallfeldt KK, Mussack T (2005) Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res 10(6):247–253PubMed

20.

Conze J, Kingsnorth AN, Flament JB, Simmermacher R, Arlt G, Langer C, Schippers E, Hartley M, Schumpelick V (2005) Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair. Br J Surg 92(12):1488–1493. https://doi.org/10.1002/bjs.5208CrossRefPubMed

21.

Berrevoet F, Maes L, De Baerdemaeker L, Rogiers X, Troisi R, de Hemptinne B (2010) Comparable results with 3-year follow-up for large-pore versus small-pore meshes in open incisional hernia repair. Surgery 148(5):969–975. https://doi.org/10.1016/j.surg.2010.02.011CrossRefPubMed

22.

Groene SA, Prasad T, Lincourt AE, Augenstein VA, Sing R, Heniford BT (2016) Prospective, multi-institutional surgical and quality-of-life outcomes comparison of heavyweight, midweight, and lightweight mesh in open ventral hernia repair. Am J of Surg 212(6):1054–1062. https://doi.org/10.1016/j.amjsurg.2016.09.003CrossRef

23.

Rogmark P, Ekberg O, Montgomery A (2017) Long-term retromuscular and intraperitoneal mesh size changes within a randomized controlled trial on incisional hernia repair, including a review of the literature. Hernia : J Hern Abdominal Wall Surg 21(5):687–696. https://doi.org/10.1007/s10029-017-1624-9CrossRef

24.

Heniford BT, Ross SW, Wormer BA, Walters AL, Lincourt AE, Colavita PD, Kercher KW, Augenstein VA (2020) Preperitoneal ventral hernia repair: a decade long prospective observational study with analysis of 1023 patient outcomes. Ann Surg 271(2):364–374. https://doi.org/10.1097/SLA.0000000000002966CrossRefPubMed

25.

Makam R, Chamany T, Nagur B, Bilchod S, Kulkarni A (2023) Laparoscopic subcutaneous onlay mesh repair for ventral hernia: our early experience. J Minimal Access Surg 19(2):223. https://doi.org/10.4103/jmas.jmas_225_22CrossRef

26.

Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183. https://doi.org/10.1007/s10029-011-0879-9CrossRefPubMed

27.

Burger JWA, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240(4):578–585. https://doi.org/10.1097/01.sla.0000141193.08524.e7CrossRefPubMedPubMedCentral

28.

Maskal S, Miller B, Ellis R, Phillips S, Prabhu A, Beffa L, Krpata D, Rosenblatt S, Rosen M, Petro C (2023) Mediumweight polypropylene mesh fractures after open retromuscular ventral hernia repair: Incidence and associated risk factors. Surg Endosc. https://doi.org/10.1007/s00464-023-10039-4CrossRefPubMed

29.

Miller BT, Baier KF, Zolin SJ, Huang L-C, Phillips S, Petro CC, Beffa LRA, Krpata DM, Rosen MJ, Prabhu AS (2023) Long-term outcomes of seromas after ventral hernia repair: A propensity score-matched analysis of the abdominal core health quality collaborative. Hernia J Hernias Abd Wall Surg 27(2):373–378. https://doi.org/10.1007/s10029-022-02613-xCrossRef

30.

Marcolin P, de Figueiredo SMP, Constante MM, de Melo VMF, de Araújo SW, Mao R-MD, Lu R (2023) Drain placement in retromuscular ventral hernia repair: a systematic review and meta-analysis. Hernia J Hernias Abd Wall Surg. https://doi.org/10.1007/s10029-023-02792-1CrossRef

31.

Rickert A, Kienle P, Kuthe A, Baumann P, Engemann R, Kuhlgatz J, von Frankenberg M, Knaebel HP, Büchler MW (2012) A randomised, multi-centre, prospective, observer and patient blind study to evaluate a non-absorbable polypropylene mesh vs a partly absorbable mesh in incisional hernia repair. Langenbeck’s Arch Surg 397(8):1225–1234. https://doi.org/10.1007/s00423-012-1009-6CrossRef

Title: Heavyweight versus non-heavyweight mesh in ventral hernia repair: a systematic review and meta-analysis
Authors: Bruna Oliveira Trindade
Patrícia Marcolin
Gabriela R Brandao
Sarah Bueno Motter
Sérgio Mazzola Poli de Figueiredo
Rui-Min Diana Mao
Richard Lu
Publication date: 30-08-2023
Publisher: Springer Paris
Keywords: Seroma
Wound Infection
Hematoma
Published in: Hernia / Issue 2/2024
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-023-02865-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Heavyweight versus non-heavyweight mesh in ventral hernia repair: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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