Mesh position for hernia prophylaxis after midline laparotomy: A systematic review and network meta-analysis of randomized clinical trials

Tansawet, Amarit; Numthavaj, Pawin; Techapongsatorn, Suphakarn; Wilasrusmee, Chumpon; Attia, John; Thakkinstian, Ammarin

doi:10.1016/j.ijsu.2020.08.059

Cited by 23 publications

(16 citation statements)

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“…We conducted an RBA on the findings from our previous NMA that compared and ranked the effect and safety of various mesh-augmented fascia closure techniques on hernia prophylaxis in midline laparotomy [20]. Our results suggest RM might be the optimal mesh technique considering the benefits of lowering IH and the risk of SSI and CSH compared with OM.…”

Section: Discussionmentioning

confidence: 99%

“…Long-term mesh-related complications (e.g., mesh migration, enterocutaneous fistula, and chronic infection) are also very important, although they are quite rare. However, we could not assess them in the current analysis because most original RCTs included in the previous NMA [20] followed patients up in a relatively short time (2-3 years) which may not be long enough to detect them. As a foreign body, mesh could induce fibrosis and migrate into visceral organs, especially if bare mesh was exposed to those organs.…”

Section: Discussionmentioning

confidence: 99%

“…This current analysis is a part of NMA published in the International Journal of Surgery Volume 83 November 2020 [20]. The previous NMA was conducted in line with the PRISMA [22] and AMSTAR [23] guideline and registered with PROSPERO (CRD42019145939).…”

Section: Methodsmentioning

confidence: 99%

“…In addition, meta-analyses [14][15][16][17][18][19] have identified a 70-86% reduction in risk of IH following mesh placement during fascia closure. Our recent network meta-analysis (NMA) [20] compared mesh augmentation techniques for IH prophylaxis for onlay (OM), retrorectus (RM), preperitoneal (PM), intraperitoneal mesh (IM), and primary suture closure (PSC). Our findings suggested that only OM and RM significantly reduced IH incidence compared to PSC, but OM may lead to increased risk of seroma and surgical site infection (SSI) compared to other treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

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Risk-benefit assessment of onlay and retrorectus mesh augmentation for incisional hernia prophylaxis: A secondary analysis from network meta-analysis

Tansawet

Numthavaj

Techapongsatorn

et al. 2021

International Journal of Surgery

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Background: Mesh augmentation has proved efficacious for the prevention of incisional hernia (IH). A recent network meta-analysis (NMA) identified onlay and retrorectus mesh (OM and RM) as the most effective therapeutic options, but the risk of surgical site infection (SSI) and other complications require additional consideration. Methods:The NMA generated pooled risk differences (RD) for the benefits of reducing IH and the risk of SSI and composite seroma/hematoma (CSH) for use in Monte-Carlo data simulations with 1000 replications. Mean incremental risk-benefit ratios (IRBR), i.e., the ratio of incremental risk (or RD) and incremental benefit, and 95% confidence intervals (95% CI) were estimated with a probability of risk-benefits (PRB) across risk-benefit acceptability thresholds from the acceptability curves generated. Results:The RDs of IH were 0.237 and 0.201 lower in OM and RM than primary suture closure, compared to 0.027 and -0.001 for SSI. IRBRs (95% CI) for SSI risk were -0.118 (-0.124, -0.112) and 0.006 (-0.002, 0.013) for OM and RM, respectively. PRBs were much higher in RM than OM, especially at low acceptability thresholds of 0.05 and 0.1. IRBRs (95% CI) for CSH were -0.388 (-0.395, -0.381) and -0.105 (-0.111, -0.100) for OM and RM, respectively. RM yielded a PRB of 0.87 at an acceptability threshold of 0.2, in contrast to OM, which did not. Conclusion:Overall, RM offered improved benefit in IH prophylaxis over the risk of complications relative to OM and appeared to be the preferred treatment option for this indication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk-benefit assessment of onlay and retrorectus mesh augmentation for incisional hernia prophylaxis: A secondary analysis from network meta-analysis

Tansawet

Numthavaj

Techapongsatorn

et al. 2021

International Journal of Surgery

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“…1 Evidence from meta-analyses suggests that mesh-augmented fascia closure may reduce IH incidence in midline incision, with a risk reduction of 70%-86%. [2][3][4][5][6][7] Furthermore, a network meta-analysis 8 has indicated that mesh positioning in midline laparotomy also affects IH prophylaxis and that retrorectus mesh (RM) placement may be the most suitable option, considering both benefits and risks.…”

Section: Introductionmentioning

confidence: 99%

Midline incisional hernia prophylaxis using synthetic mesh in an emergency or urgent gastrointestinal tract surgery: a protocol for multicentre randomised clinical trial

et al. 2021

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IntroductionBetween 5% and 30% of abdominal incisions eventually result in incisional hernias (IHs) that can lead to severe complications and impaired quality of life. Unfortunately, IH repair is often unsuccessful; therefore, hernia prophylaxis is an important issue. The efficacy of mesh augmentation has been proven for hernia prophylaxis in high-risk patients, but no randomised clinical trial has evaluated prophylactic mesh placement in emergency/urgent gastrointestinal operations.Methods and analysisA multicentre, prospective randomised, open and patient–assessor blinded endpoint design will be conducted. A total of 470 patients will be enrolled and randomly allocated to retrorectus mesh augmentation with lightweight polypropylene mesh or primary suture closure. The primary outcome is IH occurrence within 24 months of follow-up, while other clinical outcomes are secondary endpoints. A cost-effectiveness analysis will be conducted from the societal and provider perspectives.Ethics and disseminationEthics approval was obtained from Ramathibodi Hospital (MURA2020/1478) and Vajira Hospital (COA164/2563). The protocol is on the process of submission to the local ethics committee of the other study sites. Results will be submitted for publication in a peer-reviewed journal.Trial registration numberTCTR20200924002.

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Fascial Dehiscence and Incisional Hernia Prediction Models: A Systematic Review and Meta‐analysis

et al. 2022

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Background Fascial dehiscence (FD) and incisional hernia (IH) pose considerable risks to patients who undergo abdominal surgery, and many preventive strategies have been applied to reduce this risk. An accurate predictive model could aid identification of high-risk patients, who could be targeted for particular care. This study aims to systematically review existing FD and IH prediction models. Methods Prediction models were identified using pre-specified search terms on SCOPUS, PubMed, and Web of Science. Eligible studies included those conducted in adult patients who underwent any kind of abdominal surgery, and reported model performance. Data from the eligible studies were extracted, and the risk of bias (RoB) was assessed using the PROBAST tool. Pooling of C-statistics was performed using a random-effect meta-analysis. [Registration: PROSPERO (CRD42021282463)]. Results Twelve studies were eligible for review; five were FD prediction model studies. Most included studies had high RoB, especially in the analysis domain. The C-statistics of the FD and IH prediction models ranged from 0.69 to 0.92, but most have yet to be externally validated. Pooled C-statistics (95% CI) were 0.80 (0.74, 0.86) and 0.81 (0.75, 0.86) for the FD (external-validation) and IH prediction model, respectively. Some predictive factors such as body mass index, smoking, emergency operation, and surgical site infection were associated with FD or IH occurrence and were included in multiple models. Conclusions Several models have been developed as an aid for FD and IH prediction, mostly with modest performance and lacking independent validation. New models for specific patient groups may offer clinical utility.

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Mesh position for hernia prophylaxis after midline laparotomy: A systematic review and network meta-analysis of randomized clinical trials

Cited by 23 publications

References 38 publications

Risk-benefit assessment of onlay and retrorectus mesh augmentation for incisional hernia prophylaxis: A secondary analysis from network meta-analysis

Risk-benefit assessment of onlay and retrorectus mesh augmentation for incisional hernia prophylaxis: A secondary analysis from network meta-analysis

Midline incisional hernia prophylaxis using synthetic mesh in an emergency or urgent gastrointestinal tract surgery: a protocol for multicentre randomised clinical trial

Fascial Dehiscence and Incisional Hernia Prediction Models: A Systematic Review and Meta‐analysis

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