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Effectiveness and Safety of Mesh Repair for Incarcerated or Strangulated Hernias: A Systematic Review and Meta-Analysis

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Abstract

Background

Hernia repair with mesh in patients with incarcerated or strangulated hernias is controversial. Moreover, the use of mesh for hernia repair with concomitant bowel resection poses a great dilemma. This study compared the outcomes of mesh and anatomic repairs in patients with acutely incarcerated or strangulated hernias.

Methods

PubMed, Embase, and Cochrane databases were searched for studies published before November 2019. Randomized controlled trials (RCTs) and prospective studies were included. We conducted meta-analyses using a random-effects model. The treatment outcome was measured by the incidence of surgical site infection (SSI), seroma formation, and hernia recurrence postoperatively.

Results

Two RCTs and six prospective studies with 978 patients were included. No significant difference in SSI incidence was observed between patients with incarcerated hernia from the mesh and anatomic repair groups. Recurrence was significantly lower in mesh repair group than in anatomic repair group (odds ratio, 0.08; 95% confidence interval, 0.01–0.45). Only two patients needed to have mesh explantation due to mesh infection. In the setting of hernia repair with concomitant bowel resection, the SSI rate with mesh repair was slightly higher, but most cases of infections were well controlled with conservative antibiotic therapy.

Conclusions

Mesh repair for incarcerated or strangulated hernias was feasible with a great benefit of lower recurrence rates. However, due to limited data, drawing conclusions regarding the use of mesh for hernia repair with concomitant bowel resection was difficult. Further studies with preset criteria for evaluating patients undergoing concomitant bowel resection may help elucidate this issue.

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Acknowledgements

This manuscript was edited by Wallace Academic Editing.

Funding

The authors received no specific funding for this work.

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Author notes

  1. Yu-Te Lin and Tzu-Yu Weng contributed equally to this study.

Authors and Affiliations

  1. Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Yu-Te Lin

  2. Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Tzu-Yu Weng

  3. Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan

    Ka-Wai Tam

  4. Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Ka-Wai Tam

  5. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan

    Ka-Wai Tam

Authors
  1. Yu-Te Lin
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Correspondence to Ka-Wai Tam.

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Lin, YT., Weng, TY. & Tam, KW. Effectiveness and Safety of Mesh Repair for Incarcerated or Strangulated Hernias: A Systematic Review and Meta-Analysis. World J Surg 44, 2176–2184 (2020). https://doi.org/10.1007/s00268-020-05430-4

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  • DOI: https://doi.org/10.1007/s00268-020-05430-4

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