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Efficacy and safety of mesh closure in preventing wound failure following emergency laparotomy: a systematic review and meta-analysis

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Abstract

Aims

To evaluate comparative outcomes of emergency laparotomy closure with and without prophylactic mesh.

Methods

A systematic review was performed via literature databases: PubMed, Cochrane Library, Science Direct, and Google Scholar. Studies were examined for eligibility and included if they compared prophylactic mesh closure to the conventional laparotomy closure following emergency abdominal surgery. Both acute wound failure and incisional hernia (IH) occurence were our primary outcomes. Secondary outcomes included surgical site infection (SSI), seroma/hematoma formation, Clavien-Dindo complications (score ≥ 3), total operative time, and length of hospital stay (LOS).

Results

Two randomised controlled trials (RCTs) and four comparative studies with a total of 817 patients met the inclusion criteria. Overall acute wound failure and incisional hernia rate was significantly lower in the mesh group compared to non-mesh group (odd ratio (OR) 0.23, p = 0.002) and (OR 0.21, p = 0.00001), respectively. There was no significant difference between the two groups regarding the following outcomes: total operative time (mean difference (MD) 21.44, p = 0.15), SSI (OR 1.47, p = 0.06), seroma/haematoma formation (OR 2.74, p = 0.07), grade ≥ 3 Clavien-Dindo complications (OR 2.39, p = 0.28), and LOS (MD 0.26, p = 0.84).

Conclusion

The current evidence for the use of prophylactic mesh in emergency laparotomy is diverse and obscure. Although the data trends towards a reduction in the incidence of IH, a reliable conclusion requires further high-quality RCTs to fully assess the efficacy and safety of mesh use in an emergency setting.

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Authors and Affiliations

  1. Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, UK

    Mohamed Albendary, Ali Yasen Y. Mohamedahmed, Shantanu Rout, Anil George & Shafquat Zaman

  2. Altnagelvin Area Hospital, Londonderry, UK

    Amin Alamin

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  1. Mohamed Albendary
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  2. Ali Yasen Y. Mohamedahmed
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Contributions

Conception and design: MA, AYYM, SZ. Literature search and study selection: MA, AYYM. Data collection, analysis, and interpretation: MA, AYYM, SZ. Writing the article and critical revision: all authors. Final approval of the article: all authors. Statistical analysis: AYYM, MA.

Corresponding author

Correspondence to Ali Yasen Y. Mohamedahmed.

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Ethical approval

Considering the nature of this study, ethical approval was not required.

Human and animal rights

This study is a systematic review with meta-analysis of outcomes which does not include research directly involving human or animal participation.

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Considering the nature of this study, informed consent was not required.

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The authors declare no competing interests.

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Mohamed Albendary and Ali Yasen Y Mohamedahmed had equal contribution in this study proposing joint first authorship.

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Albendary, M., Mohamedahmed, A.Y.Y., Alamin, A. et al. Efficacy and safety of mesh closure in preventing wound failure following emergency laparotomy: a systematic review and meta-analysis. Langenbecks Arch Surg 407, 1333–1344 (2022). https://doi.org/10.1007/s00423-021-02421-4

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