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Fascial defect closure versus bridged repair in laparoscopic ventral hernia mesh repair: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Purpose

Several studies have examined effectiveness of primary fascial defect closure (FDC) versus bridged repair (no-FDC) during laparoscopic ventral hernia mesh repair (LVHMR). The purpose of this study was to systematically review and meta-analyse randomized controlled trials (RCTs) which compared safety and effectiveness of two techniques.

Methods

Systematic literature searches (EMBASE, MEDLINE, PubMed, and CINAHL) were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines using predefined terms. RCTs comparing FDC and no-FDC in LVHMR were identified and retrieved. Primary outcomes were risk of recurrence and risk of major complications analyzed as a single composite outcome. Secondary outcomes were risks of seroma formation, clinical or radiologically confirmed eventration, incidence of readmission to hospital, postoperative changes in quality of life (QoL), and postoperative pain. Random effects modeling to summarize statistics were performed. The risk of bias was assessed using Cohrane’s Risk of Bias tool 2.

Results

Three RCTs that enrolled total of 259 patients were included. There was clinical heterogeneity present between studies related to patients’ characteristics, hernia characteristics, and operative techniques. There was no difference found in primary outcomes, risks of seroma formation, eventration, and chronic pain. There is conflicting evidence on how both techniques affect postoperative QoL or early postoperative pain.

Conclusions

Both techniques were detected to have equal safety profile and do not differ in risk of recurrence, seroma formation, risks of clinical or radiological eventration. Giving uncertainty and clinical equipoise, another RCT examining FDC vs no-FDC laparoscopic mesh repair separately for primary and secondary hernias using narrow inclusion criteria for hernia size on well-defined population would be ethical and pragmatic.

Prospero registration

CRD42021274581.

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Availability of data and material

Data available on reasonable request.

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Authors and Affiliations

  1. Severn PGME School of Surgery, Bristol, UK

    Y. Tryliskyy

  2. The University of Edinburgh, Edinburgh, UK

    Y. Tryliskyy & C. S. Wong

  3. University of South Wales, Cardiff, UK

    I. Demykhova

  4. Shupyk National Healthcare University of Ukraine, Kiev, Ukraine

    V. Tyselskyi & A. Kebkalo

  5. Northwestern Medical Group, Chicago, IL, USA

    V. Poylin

  6. North Bristol Trust, NHS, Bristol, UK

    D. J. Pournaras

Authors
  1. Y. Tryliskyy
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  2. C. S. Wong
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  3. I. Demykhova
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  4. V. Tyselskyi
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  5. A. Kebkalo
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Correspondence to Y. Tryliskyy.

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Conflict of interest

YT, CSW, ID, VT, AK, and VP have no conflicts of interest or financial ties to disclose. DP received consulting fees from Johnson and Johnson and payment or honoraria for educational events from Johnson and Johnson, Medtronic, Novo Nordisk. These benefits were not related to this manuscript.

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Tryliskyy, Y., Wong, C.S., Demykhova, I. et al. Fascial defect closure versus bridged repair in laparoscopic ventral hernia mesh repair: a systematic review and meta-analysis of randomized controlled trials. Hernia 26, 1473–1481 (2022). https://doi.org/10.1007/s10029-021-02533-2

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  • DOI: https://doi.org/10.1007/s10029-021-02533-2

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