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Retromuscular prophylactic mesh reinforcement after midline laparotomy: a systematic review and meta-analysis
Melissa Lagger1,2, Sguinzi Raffaella3, Buhler Leo3,4
1Department of Surgery, Cantonal Hospital of Fribourg, Chemin Des Pensionnats 2/6, 1752, Villars-Sur-Glâne, Fribourg, Switzerland. melissa.lagger@h-fr.ch.
Hernia : the Journal of Hernias and Abdominal Wall Surgery
|December 26, 2025
Summary
Retromuscular prophylactic mesh reinforcement (PMR) significantly lowers incisional hernia rates after elective laparotomy, especially with synthetic mesh. More research is needed for contaminated or emergency settings.
Area of Science:
- Abdominal Surgery
- Surgical Innovation
- Hernia Repair
Background:
- Incisional hernias (IH) are common after laparotomy, causing morbidity and costs.
- Guidelines suggest prophylactic mesh reinforcement (PMR) for high-risk elective cases.
- Optimal mesh placement is in the retromuscular plane for better outcomes.
Purpose of the Study:
- To assess retromuscular PMR's effectiveness and safety in reducing IH after midline laparotomies.
- To compare PMR against primary suture closure (PSC) in elective and contaminated/emergency settings.
Main Methods:
- Systematic review and meta-analysis of 8 RCTs (1167 patients).
- Included elective or contaminated/emergency midline laparotomies comparing retromuscular PMR vs. PSC.
- Primary outcome: IH incidence. Secondary outcomes: surgical site infection (SSI), seroma, hematoma.
Main Results:
- PMR significantly reduced IH risk versus PSC (OR 0.37), with high heterogeneity (I²=74%).
- Synthetic mesh showed a significant benefit (OR 0.18), but biologic mesh did not.
- No significant SSI difference; trends toward increased seroma and hematoma.
Conclusions:
- Retromuscular PMR effectively reduces IH in elective laparotomy, particularly with synthetic mesh.
- No increase in major infectious complications was observed.
- Evidence for contaminated/emergency settings is limited; substantial heterogeneity impacts certainty.
