Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands.
Department of General and Digestive Surgery, Hospital Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain.
BJS Open. 2020 Jun;4(3):357-368. doi: 10.1002/bjs5.50261. Epub 2020 Feb 14.
Incisional hernia is a frequent complication after abdominal surgery. The aim of this study was to assess the efficacy of prophylactic mesh reinforcement (PMR) after midline laparotomy in reducing the incidence of incisional hernia.
A meta-analysis was conducted following PRISMA guidelines. The primary outcome was the incidence of incisional hernia after follow-up of at least 12 months. Secondary outcomes were postoperative complications. Only RCTs were included. A random-effects model was used for the meta-analysis, and trial sequential analysis was conducted.
Twelve RCTs were included, comprising 1815 patients. The incidence of incisional hernia was significantly lower after PMR compared with sutured closure (risk ratio (RR) 0·35, 95 per cent c.i. 0·21 to 0·57; P < 0·001). Both onlay (RR 0·26, 0·11 to 0·67; P = 0·005) and retromuscular (RR 0·28, 0·10 to 0·82; P = 0·02) PMR led to a significant reduction in the rate of incisional hernia. The occurrence of seroma was higher in patients who had onlay PMR (RR 2·23, 1·10 to 4·52; P = 0·03). PMR did not result in an increased rate of surgical-site infection.
PMR of a midline laparotomy using an onlay or retromuscular technique leads to a significant reduction in the rate of incisional hernia in high-risk patients. Individual risk factors should be taken into account to select patients who will benefit most. [Correction added on 19 February 2020, after first online publication: J. García Alamino has been amended to J. M. Garcia-Alamino].
切口疝是腹部手术后常见的并发症。本研究旨在评估腹部正中切开术后预防性使用补片加强（PMR）以降低切口疝发生率的效果。
根据 PRISMA 指南进行荟萃分析。主要结局是随访至少 12 个月后的切口疝发生率。次要结局是术后并发症。仅纳入 RCTs。采用随机效应模型进行荟萃分析，并进行试验序贯分析。
共纳入 12 项 RCTs，包含 1815 例患者。与缝合关闭相比，PMR 后切口疝发生率显著降低（风险比（RR）0.35，95%置信区间 0.21 至 0.57；P<0.001）。无论是网片上置（RR 0.26，0.11 至 0.67；P=0.005）还是腹直肌后（RR 0.28，0.10 至 0.82；P=0.02）PMR 都显著降低了切口疝的发生率。网片上置 PMR 患者的血清肿发生率更高（RR 2.23，1.10 至 4.52；P=0.03）。PMR 并未导致手术部位感染发生率增加。
对于高危患者，采用网片上置或腹直肌后技术对腹部正中切开术进行 PMR 可显著降低切口疝发生率。应考虑个体危险因素，以选择最能从中获益的患者。
