Prophylactic mesh augmentation after laparotomy for elective and emergency surgery: meta-analysis

Area of Science:

• Surgical Innovation
• Abdominal Surgery
• Hernia Repair

Background:

• Incisional hernia is a common complication following laparotomy, leading to significant patient morbidity.
• Current surgical practices for laparotomy closure vary, necessitating an updated review of effective techniques.
• Prophylactic mesh augmentation is an emerging strategy to mitigate hernia development.

Approach:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
• Searched Scopus, PubMed, and Web of Science databases up to June 2022 for relevant RCTs.
• Included RCTs comparing prophylactic mesh augmentation versus no mesh in elective or emergency midline laparotomy.

Key Points:

• Prophylactic mesh augmentation significantly reduced incisional hernia risk at all follow-up points (1-4 years).
• Risk ratio for incisional hernia was consistently lower in the mesh group (e.g., 0.31 at 1 year, 0.38 at 4 years).
• A non-significant increase in wound complications was observed in the mesh augmentation group.

Conclusions:

• Midline laparotomy closure with prophylactic mesh augmentation is safe and effective in lowering incisional hernia incidence.
• Surgeons should consider prophylactic mesh augmentation, particularly for high-risk patients and in emergency settings.
• Further research is needed to determine optimal mesh types and positioning techniques.