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Prophylactic Onlay Mesh Repair (POMR) Versus Primary Suture Repair (PSR) for Prevention of Incisional Hernia (IH) After Abdominal Wall Surgery: A Systematic Review and Meta-analysis

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Abstract

Background

With many different operative techniques in use to reduce the incidence of incisional hernias (IH) following a midline laparotomy, there is no consensus among the clinicians on the efficacy and safety of any particular repair technique. This meta-analysis compares the prophylactic onlay mesh repair (POMR) and primary suture repair (PSR) for the incidence of IH.

Methods

A meta-analysis and systematic review of MEDLINE, PubMed Central (via PubMed), Embase (via Ovid), SCOPUS, ScienceDirect, Google Scholar, SCI and Cochrane Library databases were undertaken. Seven randomized controlled trials assessing the outcomes of PSR and POMR were analyzed in accordance with the PRISMA statement. The risk of bias was assessed using the Rob2 tool.

Results

According to the pooled analysis, POMR significantly reduced the incidence of IH compared to the PSR (OR 5.82 [95% CI 2.69, 12.58] P < 0.01) with a significantly higher seroma formation rate post-surgery (OR 0.35 [95% CI 0.18, 0.67] P < 0.01). Furthermore, the length of hospital stay (WMD −0.78 [95% CI −1.58, 0.02] P = 0.05) was significantly shorter for PSR compared to POMR group. Comparable effects were noted for reintervention, postoperative ileus, postoperative hematoma, postoperative mortality, long-term intervention and long-term deaths between the two groups.

Conclusions

POMR significantly reduces the risk of IH when compared to the PSR, with an increased risk of postoperative seroma formation and longer hospital stay. However, more RCTs with standardized protocols are needed for meaningful comparisons of the two interventions, along with longer duration of follow-up to assess the impact on the occurrence of IH.

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The authors report no external funding source for this study.

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Authors and Affiliations

  1. MAP Center for Urban Health Solutions, St. Michael’s Hospital, 3rd floor, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada

    Maha Awaiz Hassan

  2. Institute of Mathematical Sciences, Faculty of Science, Universiti Malaya, Kuala Lumpur, Malaysia

    Rossita Mohamad Yunus

  3. School of Sciences, Centre for Health Sciences Research, University of Southern Queensland, Toowoomba, QLD, Australia

    Shahjahan Khan & Muhammed Ashraf Memon

  4. South East Queensland Surgery (SEQS), Sunnybank Obesity Centre, Sunnybank, QLD, Australia

    Muhammed Ashraf Memon

  5. Mayne Medical School, School of Medicine, University of Queensland, Brisbane, QLD, Australia

    Muhammed Ashraf Memon

  6. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia

    Muhammed Ashraf Memon

  7. Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK

    Muhammed Ashraf Memon

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  1. Maha Awaiz Hassan
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Hassan, M.A., Yunus, R.M., Khan, S. et al. Prophylactic Onlay Mesh Repair (POMR) Versus Primary Suture Repair (PSR) for Prevention of Incisional Hernia (IH) After Abdominal Wall Surgery: A Systematic Review and Meta-analysis. World J Surg 45, 3080–3091 (2021). https://doi.org/10.1007/s00268-021-06238-6

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