Prophylactic mesh augmentation after laparotomy for elective and emergency surgery: meta-analysis

Author:

Frassini Simone12ORCID,Calabretto Francesca12,Granieri Stefano3ORCID,Fugazzola Paola12ORCID,Massaro Matteo12,Sargenti Benedetta12,Schiavone Luca12,Zanghì Simone12,Dal Mas Francesca4,Ansaloni Luca12,Cobianchi Lorenzo12

Affiliation:

1. General Surgery Residency, University of Pavia , Pavia , Italy

2. Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo , Pavia , Italy

3. General Surgery Unit, ASST-Brianza, Vimercate Hospital , Vimercate , Italy

4. Department of Management, Università Ca’ Foscari , Venezia , Italy

Abstract

Abstract Background Incisional hernia is a common short- and long-term complication of laparotomy and can lead to significant morbidity. The aim of this systematic review and meta-analysis is to provide an up-to-date overview of the laparotomy closure method in elective and emergency settings with the prophylactic mesh augmentation technique. Methods The Scopus, PubMed, and Web of Science databases were screened without time restrictions up to 21 June 2022 using the keywords ‘laparotomy closure’, ‘mesh’, ‘mesh positioning’, and ‘prophylactic mesh’, and including medical subject headings terms. Only RCTs reporting the incidence of incisional hernia and other wound complications after elective or emergency midline laparotomy, where patients were treated with prophylactic mesh augmentation or without mesh positioning, were included. The primary endpoint was to explore the risk of incisional hernia at different follow-up time points. The secondary endpoint was the risk of wound complications. The risk of bias for individual studies was assessed according to the Revised Cochrane risk-of-bias tools for randomized trials. Results Eighteen RCTs, including 2659 patients, were retrieved. A reduction in the risk of incisional hernia at every time point was highlighted in the prophylactic mesh augmentation group (1 year, risk ratio 0.31, P = 0.0011; 2 years, risk ratio 0.44, P < 0.0001; 3 years, risk ratio 0.38, P = 0.0026; 4 years, risk ratio 0.38, P = 0.0257). An increased risk of wound complications was highlighted for patients undergoing mesh augmentation, although this was not significant. Conclusions Midline laparotomy closure with prophylactic mesh augmentation can be considered safe and effective in reducing the incidence of incisional hernia. Further trials are needed to identify the ideal type of mesh and technique for mesh positioning, but surgeons should consider prophylactic mesh augmentation to decrease incisional hernia rate, especially in high-risk patients for fascial dehiscence and even in emergency settings. PROSPERO registration ID CRD42022336242 (https://www.crd.york.ac.uk/prospero/record_email.php).

Publisher

Oxford University Press (OUP)

Subject

General Medicine

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