, Volume 23, Issue 5, pp 831–845 | Cite as

Pooled data analysis of primary ventral (PVH) and incisional hernia (IH) repair is no more acceptable: results of a systematic review and metanalysis of current literature

  • C. Stabilini
  • G. CavallaroEmail author
  • P. Dolce
  • S. Capoccia Giovannini
  • F. Corcione
  • M. Frascio
  • M. Sodo
  • G. Merola
  • U. Bracale
Part of the following topical collections:
  1. Forum on primary midline uncomplicated ventral hernia



Primary (PVHs) and incisional (IHs) ventral hernias represent a common indication for surgery. Nevertheless, most of the papers presented in literature analyze both types of defect together, thus potentially introducing a bias in the results of interpretation. The purpose of this systematic review and meta-analysis is to highlight the differences between these two entities.


Methods MEDLINE, Scopus, and Web of Science databases were reviewed to identify studies evaluating the outcomes of both open and laparoscopic repair with mesh of PVHs vs IHs. Search was restricted to English language literature. Risk of bias was assessed with MINORS score. Primary outcome was recurrence, and secondary outcomes were baseline characteristics and intraoperative and postoperative data. Fixed effects model was used unless significant heterogeneity, assessed with the Higgins I square (I2), was encountered.


The search resulted in 783 hits, after screening; 11 retrospective trials were selected including 38,727 patients. Mean MINORS of included trials was 15.2 (range 5–21). The estimated pooled proportion difference for recurrence was − 0.09 (− 0.11; − 0.07) between the two groups in favor of the PVH group. On metanalysis, PVHs were smaller in area and diameters, affected younger and less comorbid patients, and were more frequently singular; the operative time and length of stay was quicker. Other complications did not differ significantly.


Our paper supports the hypothesis that PVH and IH are different conditions with the latter being more challenging to treat. Accordingly, EHS classifications should be adopted systematically as well as pooling data analysis should be no longer performed in clinical trials.


Primary ventral hernia Incisional hernia Abdominal wall hernia classification Pooled analysis Mesh repair Abdominal wall repair 



The present meta-analysis or authors did not receive any funding.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

Approval from the institutional review board was not required for this study.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Supplementary material

10029_2019_2033_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 25 kb) Supplementary Material 1. PRISMA checklist for systematic reviews and metanalyses


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgical ScienceUniversity of Genoa, Policlinico San Martino IRCCSGenoaItaly
  2. 2.General and Laparoscopic Surgery Unit, Department of Surgery “P. Valdoni”Sapienza UniversityRomeItaly
  3. 3.Department of Public HealthFederico II UniversityNaplesItaly
  4. 4.Department of Advanced Biomedical SciencesFederico II UniversityNaplesItaly

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