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Surgical site occurrence after prophylactic use of mesh for prevention of incisional hernia in midline laparotomy: systematic review and meta-analysis of randomized clinical trials

  • 2023 SAGES Oral
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Abstract

Background

The use of mesh is the standard for the prevention of incisional hernia (IH). However, the effect of surgical site occurrence (SSO) has never been compared. The aim of this meta-analysis was to evaluate the prevalence of SSO and measure its negative effect through the calculation of the number needed to treat for net effect (NNT net).

Methods

A meta-analysis was performed according to the PRISMA guidelines. The primary objective was to determine the prevalence of SSO and IH, and the secondary objective was to determine the NNT net as a metric to measure the combined benefits and harms. Only published clinical trials were included. The risk of bias was analyzed, and the random effects model was used to determine statistical significance.

Results

A total of 15 studies comparing 2344 patients were included. The incidence of IH was significantly lower in the mesh group than in the control group, with an OR of 0.29 (95% CI 0.16–0.49, p = 0.0001). The incidence of SSO was higher in the mesh group than in the control group, with an OR of 1.21 (95% CI 0.85–1.72, p = 0.0001) but without statistical significance. Therefore, the way to compare the benefits and risks of each of the studies was done with the calculation of the NNT net, which is the average number of patients who need to be treated to see the benefit exceeding the harm by one event, and the result was 5, which is the average number of patients who need to be treated to see the benefit exceeding the harm by one event.

Conclusion

The use of mesh reduces the prevalence of IH and it does not increases the prevalence of SSO, the NNT net determined that the use of mesh continues to be beneficial for the patient.

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Data availability

Online Appendix 1: The full dataset will be freely available online in Mendeley Data, a secure online repository for research data, which allows archiving of any file type and assigns a permanent and unique digital object identifier (DOI) so that the files can be easily referenced: https://doi.org/10.17632/bhx97wzw29.2. The database is available for review.

Abbreviations

IH:

Incisional hernia

SSO:

Surgical site occurrence

SSI:

Surgical site infection

OR:

Odds ratio

CI:

Confidence interval

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

NNT:

Number needed to treat

NNTB:

Number needed to treat for benefit

NNTH:

Number needed to treat for harm

ARR:

Absolute risk reduction

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Authors and Affiliations

  1. Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico

    Edgard Efrén Lozada Hernández, Diego Hinojosa Ugarte, Rafal Ludwik Smolinski Kurek, Bruno Crocco Quirós, Roland Kevin Cethorth Fonseca, Alfonso Sánchez Téran & Michelle Macias Grageda

  2. Regional Hospital of High Specialty of Bajio, León, Guanajuato, Mexico

    Irma Lisseth Maldonado Barrios & Sebastián Amador Ramírez

  3. UMF-94, Mexican Institute of Security Social, Mexico City, Mexico

    Jonathan Lennie Rodríguez Casillas

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Contributions

LHEE, ILMB, MMG and SAR: protocol/project development, data collection or management, manuscript writing/editing, data analysis. JLRC, DHU, RLSK, BCQ, RKCF, and AST: protocol/project development, data collection or management. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Edgard Efrén Lozada Hernández.

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Disclosures

Edgard Efrén Lozada Hernández, Irma Lisseth Maldonado-Barrios, Sebastián Amador-Ramírez, Jonathan Lennie Rodríguez Casillas, Diego Hinojosa Ugarte, Rafal Ludwik Smolinski Kurek, Bruno Crocco Quirós, Roland Kevin Cethorth Fonseca, Alfonso Sánchez Téran, Michelle Macias Grageda have no conflicts of interest or financial ties to disclose.

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This review was approved by the local committee for clinical research and ethics committee: Number registration: CEI/HRAEB/003/2023. Registered in the PROSPERO database with number CRD 42023413405.

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Appendix

Appendix

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Table 2 Characteristics of RCT included in the meta-analysis
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Lozada Hernández, E.E., Maldonado Barrios, I.L., Amador Ramírez, S. et al. Surgical site occurrence after prophylactic use of mesh for prevention of incisional hernia in midline laparotomy: systematic review and meta-analysis of randomized clinical trials. Surg Endosc 38, 942–956 (2024). https://doi.org/10.1007/s00464-023-10509-9

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