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Prophylactic mesh augmentation in emergency laparotomy closure: a meta-analysis of randomized controlled trials with trial sequential analysis

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Abstract

Background

Prophylactic mesh augmentation in emergency laparotomy closure is controversial. We aimed to perform a meta-analysis of randomized controlled trials (RCT) evaluating the placement of prophylactic mesh during emergency laparotomy.

Methods

We performed a systematic review of Cochrane, Scopus, and PubMed databases to identify RCT comparing prophylactic mesh augmentation and no mesh augmentation in patients undergoing emergency laparotomy. We excluded observational studies, conference abstracts, elective surgeries, overlapping populations, and trial protocols. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. Risk of bias was assessed using the revised Cochrane risk-of-bias tool (RoB 2). The review protocol was registered at PROSPERO (CRD42023412934).

Results

We screened 1312 studies and 33 were thoroughly reviewed. Four studies comprising 464 patients were included in the analysis. Mesh reinforcement was significantly associated with a decrease in incisional hernia incidence (OR 0.18; 95% CI 0.07–0.44; p < 0.001; I2 = 0%), and synthetic mesh placement reduced fascial dehiscence (OR 0.07; 95% CI 0.01–0.53; p = 0.01; I2 = 0%). Mesh augmentation was associated with an increase in operative time (MD 32.09 min; 95% CI 6.39–57.78; p = 0.01; I2 = 49%) and seroma (OR 3.89; 95% CI 1.54–9.84; p = 0.004; I2 = 0%), but there was no difference in surgical-site infection or surgical-site occurrences requiring procedural intervention or reoperation.

Conclusions

Mesh augmentation in emergency laparotomy decreases incisional hernia and fascial dehiscence incidence. Despite the risk of seroma, prophylactic mesh augmentation appears to be safe and might be considered for emergency laparotomy closure. Further studies evaluating long-term outcomes are still needed.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. School of Medicine, Universidade Federal da Fronteira Sul, Passo Fundo, RS, Brazil

    P. Marcolin

  2. Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA

    S. Mazzola Poli de Figueiredo, R.-M. D. Mao & J. M. Moffett

  3. School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil

    B. Oliveira Trindade, S. Bueno Motter & G. R. Brandão

Authors
  1. P. Marcolin
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Contributions

SMPF conceived the idea and study design. PM, BOT and SBM participated in the data collection and analysis. All authors participated in the data interpretation, writing and critical revision of the work.

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Correspondence to P. Marcolin.

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Due to the nature of this study, it is exempt from the requirement for ethical board registration and individual patient consent.

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Marcolin, P., Mazzola Poli de Figueiredo, S., Oliveira Trindade, B. et al. Prophylactic mesh augmentation in emergency laparotomy closure: a meta-analysis of randomized controlled trials with trial sequential analysis. Hernia (2024). https://doi.org/10.1007/s10029-023-02943-4

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