Recurrence of infection and hernia following partial versus complete removal of infected hernia mesh: a systematic review and cohort meta-analysis
- 27 Downloads
The aim of this systematic review and meta-analysis was to determine whether complete removal of infected hernia mesh (CMR) provides better results as compared to partial removal (PMR).
PubMed, EMBASE, Cochrane Library, and MEDLINE via Ovid were systematically searched for records published from 1980 to 2018 by three independent researchers (GM, GS, and GG). Quality assessment, data extraction and analysis were performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Mantel–Haenszel method with odds ratio and 95% confidence interval (OR (95% CI)) as the measure of effect size of dichotomous primary and secondary endpoints was utilized. Random-effects model was used for meta-analysis.
Five observational studies totaling 421 patients were included in the meta-analysis. Rates of infection recurrence were 58.5% (62/106) in PMR and 25.5% (62/315) in CMR. The difference was statistically significant [OR (95% CI) 4.15 (2.30, 7.47); p < 0.001]. Rates of hernia recurrence were 9.7% (8/82) in PMR vs. 40.2% (41/102) in CMR. This difference was not statistically significant [OR (95% CI) 0.25 (0.04, 1.62); p = 0.15]. Low risk of publication bias was found using funnel plots and Egger’s test.
This meta-analysis found significantly increased rates of infection recurrence in patients undergoing partial removal of infected hernia mesh as compared to complete removal. Complete removal of infected hernia mesh may be associated with increased rates of hernia recurrence. Further longitudinal observational studies are needed to confirm these findings.
KeywordsHernia mesh Mesh infection Surgical removal Excision Surgical site infection
All authors have contributed to the following: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study ethical approval is not required.
Human and animal rights
This paper represents a summary design study. Hence, no human subjects or animals were involved.
For this type of study formal consent is not required.
- 1.Billroth T (1924) The Medical Sciences in the German Universities: a study in the history of civilization. Welch WH, ed. Macmillan, New YorkGoogle Scholar
- 3.Lockhart K, Dunn D, Teo S et al (2018) Mesh versus non-mesh for inguinal and femoral hernia repair. Cochrane Database Syst Rev 9:011517Google Scholar
- 8.Higgins JP, Green S (2011) Cochrane handbook for systematic reviews of interventions, vol 4. Wiley, EnglandGoogle Scholar