Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Study Center of the German Surgical Society, University of Heidelberg, Heidelberg, Germany.
Hernia. 2023 Apr;27(2):225-234. doi: 10.1007/s10029-022-02675-x. Epub 2022 Sep 14.
Incisional hernia is a common complication after midline laparotomy. In certain risk profiles incidences can reach up to 70%. Large RCTs showed a positive effect of prophylactic mesh reinforcement (PMR) in high-risk populations.
The aim was to evaluate the effect of prophylactic mesh reinforcement on incisional hernia reduction in obese patients after midline laparotomies.
Following the PRISMA guidelines, a systematic literature search in Medline, Web of Science and CENTRAL was conducted. RCTs investigating PMR in patients with a BMI ≥ 27 reporting incisional hernia as primary outcome were included. Study quality was assessed using the Cochrane risk-of-bias tool and certainty of evidence was rated according to the GRADE Working Group grading of evidence. A random-effects model was used for the meta-analysis. Secondary outcomes included postoperative complications.
Out of 2298 articles found by a systematic literature search, five RCTs with 1136 patients were included. There was no significant difference in the incidence of incisional hernia when comparing PMR with primary suture (odds ratio (OR) 0.59, 95% CI 0.34-1.01, p = 0.06, GRADE: low). Meta-analyses of seroma formation (OR 1.62, 95% CI 0.72-3.65; p = 0.24, GRADE: low) and surgical site infections (OR 1.52, 95% CI 0.72-3.22, p = 0.28, GRADE: moderate) showed no significant differences as well as subgroup analyses for BMI ≥ 40 and length of stay.
We did not observe a significant reduction of the incidence of incisional hernia with prophylactic mesh reinforcement used in patients with elevated BMI. These results stand in contrast to the current recommendation for hernia prevention in obese patients.
切口疝是腹部正中切开术后的常见并发症。在某些高危人群中，发病率可高达 70%。大型随机对照试验显示，预防性补片加固（PMR）对高危人群具有积极作用。
评估预防性补片加固对腹部正中切开术后肥胖患者切口疝发生率的影响。
根据 PRISMA 指南，对 Medline、Web of Science 和 CENTRAL 进行系统文献检索。纳入研究 PMR 对 BMI≥27 且切口疝为主要结局的患者的 RCT。使用 Cochrane 偏倚风险工具评估研究质量，并根据 GRADE 工作组证据分级标准评定证据确定性。采用随机效应模型进行荟萃分析。次要结局包括术后并发症。
系统文献检索共发现 2298 篇文章，纳入 5 项 RCT 共 1136 例患者。与单纯缝合相比，PMR 并未显著降低切口疝的发生率（比值比（OR）0.59，95%置信区间（CI）0.34-1.01，p=0.06，GRADE：低）。对血清肿形成（OR 1.62，95%CI 0.72-3.65；p=0.24，GRADE：低）和手术部位感染（OR 1.52，95%CI 0.72-3.22，p=0.28，GRADE：中）的荟萃分析也未显示出显著差异，且 BMI≥40 和住院时间的亚组分析也无差异。
我们未观察到预防性补片加固在肥胖患者中能显著降低切口疝的发生率。这些结果与当前对肥胖患者预防疝的建议相悖。
