Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
World J Surg. 2021 May;45(5):1349-1361. doi: 10.1007/s00268-020-05898-0. Epub 2021 Feb 8.
Incisional hernias have an impact on patients' quality of life and on health care finances. Because of high recurrence rates despite mesh repair, the prevention of incisional hernias with prophylactic mesh reinforcement is currently a topic of interest. But only 15% of surgeons are implementing it, mainly because of fear for mesh complications and disbelief in the benefits. The goal of this systematic review is to evaluate the effectiveness and safety of prophylactic mesh in adult patients after midline laparotomy.
An extensive literature search was performed in PubMed, Embase and CENTRAL until 9/5/2020 for RCTs and cohort studies regarding mesh reinforcement versus primary suture closure of a midline laparotomy. The quality of the articles was analyzed using the Scottish Intercollegiate Guidelines Network checklists. Revman 5 was used to perform a meta-analysis.
Twenty-three articles were found with a total of 1633 patients in the mesh reinforcement group and 1533 in the primary suture group. An odds ratio for incisional hernia incidence of 0.37 (95% CI = [0.30, 0.46], p < 0.01) with RCTs and of 0.15 (95% CI = [0.09,0.25], p < 0.01) in cohort studies was calculated. Seroma rate shows a significant odds ratio of 2.18 (95% CI = [1.45, 3.29], p < 0.01) in favor of primary suture. No increase was found regarding other complications.
The evidence for the use of prophylactic mesh reinforcement is overwhelming with a significant reduction in incisional hernia rate, but implementation in daily clinical practice remains limited. Instead of putting patients at risk for incisional hernia formation and subsequent complications, surgeons should question their arguments why not to use mesh reinforcement, specifically in high-risk patients.
切口疝会影响患者的生活质量和医疗保健费用。尽管使用网片修补后复发率仍然很高，但目前仍在关注使用预防性网片加强来预防切口疝。但只有 15%的外科医生在实施这种方法，主要是因为担心网片并发症和不相信其益处。本系统评价的目的是评估成人中线剖腹术后预防性网片的有效性和安全性。
在 PubMed、Embase 和 CENTRAL 中进行了广泛的文献检索，检索时间截至 2020 年 9 月 5 日，纳入关于网片加强与中线剖腹术的一期缝合的 RCT 和队列研究。使用苏格兰校际指南网络清单分析文章的质量。Revman 5 用于进行荟萃分析。
共发现 23 篇文章，网片加强组共有 1633 例患者，一期缝合组共有 1533 例患者。RCT 计算的切口疝发生率的优势比为 0.37（95%CI=0.30,0.46），p<0.01；队列研究的优势比为 0.15（95%CI=0.09,0.25），p<0.01。计算出的血清肿发生率的优势比为 2.18（95%CI=1.45,3.29），有利于一期缝合。未发现其他并发症增加。
使用预防性网片加强的证据是压倒性的，切口疝发生率显著降低，但在日常临床实践中的实施仍然有限。外科医生不应让患者面临切口疝形成和随后并发症的风险，而应质疑他们为什么不使用网片加强的理由，特别是在高风险患者中。
