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Meta-Analysis
. 2018 Jun 6;13(6):e0197813.
doi: 10.1371/journal.pone.0197813. eCollection 2018.

Balancing mesh-related complications and benefits in primary ventral and incisional hernia surgery. A meta-analysis and trial sequential analysis

Manuel López-Cano  1 , Lidia A Martin-Dominguez  1 , José Antonio Pereira  2 , Manuel Armengol-Carrasco  1 , Josep M García-Alamino  3
Affiliations
Meta-Analysis

Balancing mesh-related complications and benefits in primary ventral and incisional hernia surgery. A meta-analysis and trial sequential analysis

Manuel López-Cano et al. PLoS One. .

Abstract

Background: Primary ventral hernia (PVH) and incisional hernia (IH) repair using a mesh appears to reduce hernia recurrence. However, are the benefits of mesh offset in part by mesh-related complications? The aim of this study was to compare placement of a mesh versus simple suture for recurrence and postoperative complications in the repair of PVH or IH.

Methods: Five databases were searched for randomized controlled trials (RCTs). The study population was patients with a PVH or IH undergoing hernia repair. Intervention was placement of a nonabsorbable synthetic mesh, regardless of mesh location, surgical technique, hernia characteristics or surgical setting compared to primary suture. Primary outcome was the incidence of hernia recurrence. Secondary outcomes were wound infection, hematoma, seroma, postsurgical pain, duration of operation, and quality of life. A random-effects meta-analysis with trial sequential analysis (TSA) was used.

Results: 10 RCTs with a total of 1270 patients were included. A significant reduction of the incidence of PVH or IH recurrence using a mesh for repair (risk ratio [RR] 0.39, 95% CI 0.27-0.55; P < 0.00001; I2 = 20%) was observed. TSA for recurrence, the accrued information size (1270) was 312% of the estimated required information size (RIS). Subgroup analysis for PVH and IH confirms reduction of recurrence after using a mesh in both groups. Overall postoperative complications did not show statistically significant differences between the mesh and surgical suture groups (RR 1.31, 95% CI 0.94-1.84; P = 0.12; I2 = 27%) but the accrued information size was only 22.4% of RIS and by subgroups complications were only related with IH repair.

Conclusions: Evidence for the efficacy of repair of PVH or IH using a nonabsorbable synthetic mesh in terms of recurrence was found to be robust. Evidence for complications remains inconclusive.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram.
Fig 2
Fig 2. Risk of bias assessment as percentages across all included studies.
Fig 3
Fig 3
Effect of placement of a mesh for a) prevention of the incidence of PVH and IH recurrence; b) PVH and IH incidence of grouped complication events (wound infection, hematoma, and seroma); c) prevention of the incidence of PVH recurrence; d) PVH incidence of grouped complication events (wound infection, hematoma, and seroma); e) prevention of the incidence of IH recurrence; f) IH incidence of grouped complication events (wound infection, hematoma, and seroma) g) prevention of the incidence of PVH and IH recurrence for high quality studies only; h) PVH and IH incidence of grouped complication events (wound infection, hematoma, and seroma) for high quality studies only.
Fig 4
Fig 4. TSA curve for the primary outcome, incidence of recurrence of primary ventral hernia and incisional hernia.
See this image and copyright information in PMC

References

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