R Payne1, J Aldwinckle2, S Ward3. 1. University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK. Robert.payne@nhs.net. 2. James Paget University Hospital, Gorleston, UK. 3. University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
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.
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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