Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy.
Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy.
Hernia. 2023 Apr;27(2):213-224. doi: 10.1007/s10029-022-02660-4. Epub 2022 Aug 3.
Incisional hernia (IH) is a common complication after abdominal surgery. Prevention of IH is matter of intense research. Prophylactic mesh reinforcement (PMR) has been shown to be promising in the minimization of IH risk after elective midline laparotomy.
Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PMR vs. primary suture closure (PSC). Risk ratio (RR) and standardized mean difference (MD) were used as pooled effect size measures whereas 95% confidence intervals (95%CI) were used to assess relative inference.
Fourteen RCTs (2332 patients) were included. Overall, 1280 (54.9%) underwent PMR while 1052 (45.1%) PSC. Postoperative follow-up ranged from 12 to 67 months. The incidence of IH was reduced for PMR vs. PSC (13.4% vs. 27.5%). The estimated pooled IH RR for PMR vs. PSC is 0.38 (95% CI 0.24-0.58; p < 0.001). Stratified subgroup analysis according to mesh location shows a risk reduction for intraperitoneal (RR = 0.65; 95% CI 0.48-0.89), preperitoneal (RR = 0.18; 95% CI 0.04-0.81), retromuscular (RR = 0.47; 95% CI 0.24-0.92) and onlay (RR = 0.24; 95% CI 0.12-0.51) compared to PSC. The seroma RR was higher for PMR (RR = 2.05; p = 0.0008). No differences were found for hematoma (RR = 1.49; p = 0.34), surgical site infection (SSI) (RR = 1.17; p = 0.38), operative time (OT) (MD = 0.27; p = 0.413), and hospital length of stay (HLOS) (MD = -0.03; p = 0.237).
PMR seems effective in reducing the risk of IH after elective midline laparotomy compared to PSC in the medium-term follow-up. While the risk of postoperative seroma appears higher for PMR, hematoma, SSI, HLOS and OT seems comparable.
切口疝（IH）是腹部手术后的常见并发症。预防 IH 是一个备受关注的研究课题。预防性补片加固（PMR）已被证明可降低择期中线剖腹手术后 IH 的风险。
对比较 PMR 与原发性缝合关闭（PSC）的随机对照试验（RCT）进行系统评价和荟萃分析。风险比（RR）和标准化均数差（MD）被用作汇总效应量的指标，95%置信区间（95%CI）用于评估相对推断。
纳入了 14 项 RCT（2332 例患者）。总体而言，1280 例（54.9%）接受了 PMR，1052 例（45.1%）接受了 PSC。术后随访时间为 12 至 67 个月。与 PSC 相比，PMR 组 IH 的发生率降低（13.4% vs. 27.5%）。PMR 与 PSC 的 IH 估计 RR 为 0.38（95% CI 0.24-0.58；p<0.001）。根据补片位置的分层亚组分析显示，腹腔内（RR=0.65；95% CI 0.48-0.89）、腹膜前（RR=0.18；95% CI 0.04-0.81）、肌后（RR=0.47；95% CI 0.24-0.92）和层间（RR=0.24；95% CI 0.12-0.51）补片的风险降低。PMR 的血清肿 RR 更高（RR=2.05；p=0.0008）。血肿（RR=1.49；p=0.34）、手术部位感染（SSI）（RR=1.17；p=0.38）、手术时间（OT）（MD=0.27；p=0.413）和住院时间（HLOS）（MD=-0.03；p=0.237）无差异。
与 PSC 相比，PMR 似乎可降低择期中线剖腹手术后 IH 的风险，在中期随访中效果较好。尽管 PMR 术后发生血清肿的风险似乎更高，但血肿、SSI、HLOS 和 OT 似乎无差异。
