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Recurrence of infection and hernia following partial versus complete removal of infected hernia mesh: a systematic review and cohort meta-analysis

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Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Surgery, Westchester Medical Center, New York Medical College, Taylor Pavilion, Suite D365, 100 Woods Road, Valhalla, NY, 10595, USA

    M. Gachabayov, S. Gogna, G. George, D. Samson & R. Latifi

Authors
  1. M. Gachabayov
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  2. S. Gogna
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  3. G. George
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  4. D. Samson
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  5. R. Latifi
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Contributions

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.

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Correspondence to M. Gachabayov.

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Gachabayov, M., Gogna, S., George, G. et al. Recurrence of infection and hernia following partial versus complete removal of infected hernia mesh: a systematic review and cohort meta-analysis. Hernia 24, 433–439 (2020). https://doi.org/10.1007/s10029-019-02095-4

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