gms | German Medical Science

Background: Primary and incisional ventral hernia repair is one of the most common surgical procedures in abdominal surgery. Today, ventral hernia repair is predominantly performed with meshes, but there is no meta-analysis of high quality evidence that has compared the results of mesh to suture repair.

The objective of this systematic review with meta-analysis is to prove the effectiveness of mesh compared to suture repair considering patient centred outcomes.

Methods: A systematic literature search was performed in EMBASE, MEDLINE and CENTRAL (inception to 06/2014) and supplemental searches were performed. RCTs comparing suture versus mesh repair in primary and incisional ventral hernia repair were included. Primary outcomes were recurrence and long term pain. Data on patient characteristics, interventions and results were extracted in standardized tables. Risk of bias was assessed with the Cochrane risk of bias tool. Results of studies were pooled in a meta-analysis (random effects model).

Study selection, data extraction and risk of bias assessment were performed by two reviewers. Discrepancies were discussed until consensus.

Results: The search in the databases resulted in 1560 hits. After screening, ten RCTs including 1215 patients satisfied all inclusion criteria. Risk of bias was moderate to high. The main reason was that patients and personal were not blinded.

The relative risk for recurrence was 0.36 (95% CI [0.27, 0.49]; I² = 0; heterogeneity p = 0.70; N=10). Results for pain (N=2; n=281) were in most of the multiple measurement time points not statistical significant and effect directions between studies were conflicting. Other long term complications did not differ.

Conclusion: Mesh repair reduces the number of recurrences significantly, irrespectively of hernia size. Although the risk of bias was moderate to high in view of the large effect size it can be concluded that mesh repair is associated with less recurrence. However, evidence for chronic pain is inconclusive because of the conflicting effect directions across the studies. The conflicting effect direction might be due to the difference in the operation technique and hernias. Further studies are needed to analyse the long term effect of mesh implantation on pain.

Funding: There was no funding for this review. None of the authors has a conflict of interest.

Registration: The systematic review is not registered.