World Journal of Surgery

, Volume 40, Issue 4, pp 826–835 | Cite as

Suture Versus Mesh Repair in Primary and Incisional Ventral Hernias: A Systematic Review and Meta-Analysis

  • Tim MathesEmail author
  • Maren Walgenbach
  • Robert Siegel
Original Scientific Report



Today, ventral hernia repair is predominantly performed with meshes. There is no meta-analysis of high quality evidence that compares the results of suture to mesh repair. The objective of this systematic review with meta-analysis is to compare patient centred outcomes of suture versus mesh repair.


A systematic literature search was performed in EMBASE, MEDLINE and CENTRAL (inception to 06/2014). Furthermore a hand search was performed. RCTs comparing suture versus mesh repair in primary and incisional ventral hernia repair were included. Data on patient characteristics, interventions and results were extracted in standardized tables. Risk of bias was assessed with the cochrane risk of bias tool. Results of studies were pooled with a meta-analysis. All steps were performed by two reviewers. Discrepancies were discussed until a consensus.


The search in the databases resulted in 1560 hits. After screening, 10 randomized controlled trials including 1215 patients satisfied all inclusion criteria. Risk of bias was moderate to high. The relative risk for recurrence was 0.36 [95% CI (0.27, 0.49); I 2 = 0; heterogeneity p = 0.70]. Other complications did not differ significantly. Results for chronic pain were heterogeneous across studies.


Mesh repair reduces the number of recurrences significantly. In patients without recurrence mesh repairs seem to be associated with a risk of chronic pain especially if the mesh is fixed sublay.


Hernia Repair Incisional Hernia Ventral Hernia Mesh Repair Ventral Hernia Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Author contributions

Tim Mathes: Idea for the review, literature search, selection of literature, data extraction, risk of bias assessment, preparation of meta-analysis, writing of manuscript. Maren Walgenbach: Selection of literature, data extraction, risk of bias assessment, review of manuscript. Robert Siegel: Clinical expertise, interpretation of data, revision of manuscript.

Complaince with ethical standards

Conflict of interest

Nothing to declare.




There was no funding for this systematic review.

Supplementary material

268_2015_3311_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 kb)


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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  1. 1.Faculty of Health-School of Medicine, Institute for Research in Operative MedicineWitten/Herdecke UniversityCologneGermany
  2. 2.Department of General, Visceral and Cancer Surgery, HELIOS Klinikum Berlin-Buch and Faculty of Health-Witten/Herdecke UniversityHELIOS KlinikumBerlinGermany

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