Prophylactic closed-incision negative pressure wound therapy for open ventral incisional hernia repair with mesh: a...

To systematically evaluate the effects of prophylactic closed-incision negative pressure wound therapy (ciNPWT) on surgical site infection (SSI), seroma incidence and length of hospital stay after open ventral incisional hernia repair with mesh.

Four databases (Cochrane Library, Embase, PubMed, Web of Science) were searched from inception to June 2026 for randomized controlled trials (RCTs) comparing prophylactic ciNPWT versus conventional sterile dressings in open ventral incisional hernia repair with mesh. The primary outcome was postoperative SSI incidence; secondary outcomes included seroma incidence and hospital stay. Study quality was assessed using the Cochrane Risk of Bias tool (RoB 1.0), and meta-analysis was performed with both fixed-effect and random-effects models using RevMan software. The certainty of evidence was assessed using the GRADE approach.

Four RCTs involving 420 patients (208 in ciNPWT group, 212 in control group) were included. Under the fixed-effect model, ciNPWT tended to reduce SSI risk without statistical significance (RR = 0.52, 95% CI 0.26-1.04, P = 0.06, I²  = 50%). The random-effects model yielded a consistent but more conservative estimate (RR = 0.55, 95% CI 0.20-1.53, P = 0.25). No significant difference was found in seroma incidence (RR = 0.83, 95% CI 0.39-1.74, P = 0.61). ciNPWT was associated with shortened postoperative hospital stay (MD = -1.02 days, 95% CI -1.61 to -0.43, P = 0.0007), though this finding was based on only two studies and driven primarily by a single trial. Sensitivity analysis indicated that the SSI result was materially influenced by a single trial. Given the small number of included studies (k = 4), funnel plot asymmetry could not be reliably interpreted as evidence of publication bias. The GRADE certainty of evidence was rated as low for SSI and very low for seroma and hospital stay.

Current evidence from randomized controlled trials suggests that prophylactic ciNPWT may be associated with shortened hospital stay after mesh-based ventral incisional hernia repair and shows a non-significant trend toward reducing SSI and seroma. However, the certainty of evidence is low to very low, the SSI result is materially dependent on a single trial, and the hospital stay finding is inconsistent across studies. Therefore, no definitive conclusion can be drawn regarding infection reduction, and the hospital stay benefit requires confirmation. More large-sample, multicenter, high-quality RCTs are needed for further validation.