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Meta-Analysis
. 2020 Jun;4(3):369-379.
doi: 10.1002/bjs5.50276. Epub 2020 Apr 6.

Mesh versus suture in elective repair of umbilical hernia: systematic review and meta-analysis

L J Madsen  1 , E Oma  1 , L N Jorgensen  1 , K K Jensen  1
Affiliations
Meta-Analysis

Mesh versus suture in elective repair of umbilical hernia: systematic review and meta-analysis

L J Madsen et al. BJS Open. 2020 Jun.

Abstract
in English, Spanish

Background: Mesh repair of umbilical hernia has been associated with a reduced recurrence rate compared with suture closure, but potentially at the expense of increased postoperative complications and chronic pain. The objective of this systematic review and meta-analysis was to examine the outcomes after elective open mesh and suture repair for umbilical hernia in adults.

Methods: A literature search was conducted to identify studies presenting original data on elective open mesh and suture repair of umbilical hernia. The primary outcome was hernia recurrence. Secondary outcomes included surgical-site infection (SSI), seroma, haematoma and chronic pain. Meta-analyses were undertaken.

Results: The search resulted in 5353 hits and led to 14 studies being included (6 RCTs and 8 observational studies) describing a total of 2361 patients. Compared with suture, mesh repair was associated with a lower risk of recurrence (risk ratio (RR) 0·48, 95 per cent c.i. 0·30 to 0·77), with number needed to treat 19 (95 per cent c.i. 14 to 31). Mesh repair was associated with a higher risk of seroma (RR 2·37, 1·45 to 3·87), with number needed to harm 30 (17 to 86). There was no significant difference in the risk of SSI, haematoma or chronic pain.

Conclusion: The use of mesh in elective repair of umbilical hernia reduced the risk of recurrence compared with suture closure without altering the risk of chronic pain.

Antecedentes: La reparación con malla de la hernia umbilical se ha asociado con una tasa menor de recidivas en comparación con el cierre con suturas, pero potencialmente a expensas de un aumento de complicaciones postoperatorias y dolor crónico. El objetivo de esta revisión sistemática y metaanálisis fue examinar los resultados después de reparación abierta electiva con malla o suturas para la reparación de una hernia umbilical en adultos. MÉTODOS: Se llevó a cabo una búsqueda en la literatura para identificar estudios que presentaban datos originales sobre la reparación abierta electiva con malla y sutura de la hernia umbilical. El resultado primario fue la recidiva herniaria. Los resultados secundarios incluyeron la infección del sitio quirúrgico (surgical site infection, SSI), seroma, hematoma y dolor crónico. Se realizaron metaanálisis.

Resultados: En la búsqueda identificaron 5.353 documentos, incluyéndose 14 estudios (6 ensayos clínicos aleatorizados, 8 estudios observacionales) que presentaban datos de un total de 2.361 pacientes. En comparación con la sutura, la reparación con malla se asoció con un menor riesgo de recidiva (tasa de riesgo, risk ratio, RR 0,48, i.c. del 95% 0,30 a 0,77) y número necesario para tratar de 19 (i.c. del 95% 14 a 31). La reparación con malla se asoció con un mayor riesgo de seroma (RR 2,37, i.c. del 95% 1,45 a 3,87) y número necesario para provocar daño de 30 (i.c. del 95% 17 a 86). No hubo diferencia significativa en el riesgo de SSI, hematoma o dolor crónico. CONCLUSIÓN: El uso de malla en la reparación electiva de la hernia umbilical redujo el riesgo de recidiva en comparación con el cierre con sutura, sin modificar el riesgo de dolor crónico.

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Figures

Figure 1
Figure 1
PRISMA diagram for the review
Figure 2
Figure 2
Forest plots comparing pooled data for recurrence, surgical‐site infection, seroma and haematoma after mesh versus suture repair of umbilical hernia a Recurrence, b surgical‐site infection, c seroma and d haematoma. A Mantel–Haenszel random‐effects model was used for meta‐analysis. Risk ratios are shown with 95 per cent confidence intervals.
Figure 3
Figure 3
Forest plots comparing outcomes after mesh versus suture repair of umbilical hernia separately for RCT and cohort studies: sensitivity meta‐analysis a Recurrence, c surgical‐site infection (SSI) and e seroma in RCTs; b recurrence, d SSI and f seroma in cohort studies. Mantel–Haenszel fixed‐effect (a,c,e) and random‐effects (b,d,f) models were used for meta‐analysis. Risk ratios are shown with 95 per cent confidence intervals.
See this image and copyright information in PMC

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