Prophylactic mesh reinforcement in elective abdominal surgeries: a systematic review, meta-analysis, and GRADE evidence assessment.

IF 2.4 2区医学 Q1 SURGERY

Hernia Pub Date : 2025-07-11 DOI:10.1007/s10029-025-03421-9

Ahmed W Abbas, Mohamed F Abo-Elsoad, Mahmoud Diaa Hindawi, Mohamed Abo Zeid, Abd-Elfattah Kalmoush, Menna M Aboelkier, Mohamed A Aldemerdash, Rashad G Mohamed, Hosam Elghadban

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引用次数: 0

Abstract

Background: Elective laparotomies account for a larger fraction of laparotomy procedures performed worldwide. Although surgical techniques continue to advance, the incidence of incisional hernia (IH) and other post-operative complications remain challenging to surgeons. This study aimed to evaluate the significance of using prophylactic mesh reinforcement during elective laparotomy.

Methods: A comprehensive search was conducted in PubMed, Scopus, and Web of Science to identify studies that included adults undergoing elective abdominal surgery and compared prophylactic mesh reinforcement of the abdominal wall using any type of mesh in any anatomical position to standard fascial closure with sutures alone, without mesh. The analysis aimed to assess the impact of mesh reinforcement on the incidence of IH at all possible timepoints, in addition to secondary outcomes based on mesh technique, such as wound infections, dehiscence, seroma, re-operation for IH, and prolonged hospital stay. Data analysis was performed using the R programming language.

Results: Fifteen RCTs, including 2,233 patients with follow-up durations ranging from 1.5 to 5 years, were analyzed. Prophylactic mesh reinforcement significantly reduced the incidence of IH following elective gastrointestinal surgeries at 12 months (risk ratio [RR] = 0.35, 95% confidence interval [CI] [0.14; 0.86], p = 0.02), 24 months (RR = 0.28, 95% CI [0.11; 0.68], p < 0.01), 36 months (RR = 0.62, 95% CI [0.36; 1.06], p = 0.08), and 48 months (RR = 0.35, 95% CI [0.11; 1.17], p = 0.09). Similarly, mesh significantly reduced IH rates following open abdominal aortic aneurysm repair at 12 months (RR = 0.13, 95% CI [0.04; 0.41], p < 0.01), 24 months (RR = 0.31, 95% CI [0.21; 0.45], p < 0.01), and 36 months (RR = 0.23, 95% CI [0.10; 0.54], p < 0.01).

Conclusions: Prophylactic mesh reinforcement during elective abdominal laparotomy significantly reduced the incidence of IH and the need for reoperation. However, it is associated with an increased risk of seroma formation and, to a lesser extent, wound infection, particularly with the Sublay technique.

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选择性腹部手术预防性补片加固：系统回顾、荟萃分析和GRADE证据评估。

背景：择期剖腹手术在世界范围内剖腹手术中占较大比例。尽管手术技术不断进步，但切口疝（IH）和其他术后并发症的发生率仍然是外科医生面临的挑战。本研究旨在评价在择期剖腹手术中使用预防性补片加固的意义。方法：在PubMed， Scopus和Web of Science中进行了全面的搜索，以确定包括选择性腹部手术的成年人的研究，并比较了在任何解剖位置使用任何类型的补片进行腹壁预防性补片加固与仅使用缝合线而不使用补片的标准筋膜闭合。该分析旨在评估补片加固在所有可能时间点对IH发生率的影响，以及基于补片技术的次要结果，如伤口感染、裂开、血肿、IH再手术和延长住院时间。使用R编程语言进行数据分析。结果：分析了15项随机对照试验，包括2233例患者，随访时间从1.5年到5年不等。预防性补片加固可显著降低选择性胃肠手术后12个月IH的发生率(风险比[RR] = 0.35, 95%可信区间[CI] [0.14；0.86], p = 0.02), 24个月(RR = 0.28, 95% CI 0.11;0.68]， p结论：择期剖腹手术预防性补片加固可显著降低IH的发生率和再次手术的需要。然而，它与血肿形成的风险增加有关，并且在较小程度上与伤口感染有关，特别是使用Sublay技术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.