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Prophylactic mesh augmentation in emergency laparotomy closure: a meta-analysis of randomized controlled trials with trial sequential analysis.
Marcolin, P; Mazzola Poli de Figueiredo, S; Oliveira Trindade, B; Bueno Motter, S; Brandão, G R; Mao, R-M D; Moffett, J M.
Afiliação
  • Marcolin P; School of Medicine, Universidade Federal da Fronteira Sul, Passo Fundo, RS, Brazil. patricia.marcolin@estudante.uffs.edu.br.
  • Mazzola Poli de Figueiredo S; Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
  • Oliveira Trindade B; School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
  • Bueno Motter S; School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
  • Brandão GR; School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
  • Mao RD; Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
  • Moffett JM; Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
Hernia ; 28(3): 677-690, 2024 06.
Article em En | MEDLINE | ID: mdl-38252397
ABSTRACT

BACKGROUND:

Prophylactic mesh augmentation in emergency laparotomy closure is controversial. We aimed to perform a meta-analysis of randomized controlled trials (RCT) evaluating the placement of prophylactic mesh during emergency laparotomy.

METHODS:

We performed a systematic review of Cochrane, Scopus, and PubMed databases to identify RCT comparing prophylactic mesh augmentation and no mesh augmentation in patients undergoing emergency laparotomy. We excluded observational studies, conference abstracts, elective surgeries, overlapping populations, and trial protocols. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. Risk of bias was assessed using the revised Cochrane risk-of-bias tool (RoB 2). The review protocol was registered at PROSPERO (CRD42023412934).

RESULTS:

We screened 1312 studies and 33 were thoroughly reviewed. Four studies comprising 464 patients were included in the analysis. Mesh reinforcement was significantly associated with a decrease in incisional hernia incidence (OR 0.18; 95% CI 0.07-0.44; p < 0.001; I2 = 0%), and synthetic mesh placement reduced fascial dehiscence (OR 0.07; 95% CI 0.01-0.53; p = 0.01; I2 = 0%). Mesh augmentation was associated with an increase in operative time (MD 32.09 min; 95% CI 6.39-57.78; p = 0.01; I2 = 49%) and seroma (OR 3.89; 95% CI 1.54-9.84; p = 0.004; I2 = 0%), but there was no difference in surgical-site infection or surgical-site occurrences requiring procedural intervention or reoperation.

CONCLUSIONS:

Mesh augmentation in emergency laparotomy decreases incisional hernia and fascial dehiscence incidence. Despite the risk of seroma, prophylactic mesh augmentation appears to be safe and might be considered for emergency laparotomy closure. Further studies evaluating long-term outcomes are still needed.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Telas Cirúrgicas / Ensaios Clínicos Controlados Aleatórios como Assunto / Hérnia Incisional / Laparotomia Tipo de estudo: Clinical_trials / Observational_studies / Systematic_reviews Limite: Humans Idioma: En Revista: Hernia Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: França
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Telas Cirúrgicas / Ensaios Clínicos Controlados Aleatórios como Assunto / Hérnia Incisional / Laparotomia Tipo de estudo: Clinical_trials / Observational_studies / Systematic_reviews Limite: Humans Idioma: En Revista: Hernia Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: França