Prophylactic Mesh Placement in High-Risk Patients Undergoing Elective Laparotomy: A Systematic Review

• Published in: World journal of surgery Vol. 37; no. 8; pp. 1861 - 1871
• Main Authors: Nachiappan, Subramanian, Markar, Sheraz, Karthikesaligam, Alan, Ziprin, Paul, Faiz, Omar
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.08.2013; Springer Nature B.V
• Subjects: Abdominal Surgery; Cardiac Surgery; Clinical Trials as Topic; Elective Surgical Procedures - adverse effects; General Surgery; Hernia, Ventral - etiology; Hernia, Ventral - prevention & control; Humans; Incisional Hernia; Laparotomy - adverse effects; Medicine; Medicine & Public Health; Mesh Placement; Parastomal Hernia; Pool Odds Ratio; Risk Factors; Seroma Formation; Surgery; Surgical Mesh; Thoracic Surgery; Vascular Surgery; Incisional Hernia; Seroma Formation; Mesh Placement; Pool Odds Ratio; Parastomal Hernia
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-013-2046-1

Background Incisional hernia is a significant complication in patients undergoing elective laparotomy. Its incidence is increased in patients with risk factors, such as obesity and chronic respiratory disease. The purpose of this pooled analysis was to evaluate the use of prophylactic mesh placement following laparotomy in high-risk patients. Methods A systematic literature search of MEDLINE, Embase, Web of Science, and Cochrane database was conducted. Outcome measures were incidence of postoperative incisional hernia, seroma, and wound infection rates. Results Five randomized, controlled trials (RCTs) and four comparative studies that met the inclusion criteria were identified. In total, 464 patients who underwent laparotomy closure with mesh placement and 755 patients who underwent conventional laparotomy closure were included. A reduced incidence of incisional hernia was observed when laparotomy was combined with prophylactic mesh placement in pooled analysis of RCTs (pooled odds ratio = 0.32; 95 % confidence interval = 0.12–0.83; P  = 0.02) and comparative studies (pooled odds ratio = 0.11; 95 % confidence interval = 0.04–0.33; P  < 0.001) respectively. No significant differences were observed in the incidence of seroma or wound infection following prophylactic mesh placement. Conclusions The results of this pooled analysis suggest a benefit to prophylactic mesh placement during laparotomy closure in high-risk patients with a significantly reduced incidence of incisional hernia without any significant differences in seroma formation and wound infection rates. Further studies must evaluate the incidence of mesh-specific complications, including foreign body sensation and chronic pain, before strong recommendations can be made.