• Oscar A Olavarria, Naila H Dhanani, Karla Bernardi, Julie L Holihan, Cynthia S Bell, Tien C Ko, and Mike K Liang.
• Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas.
• Ann. Surg. 2023 Jan 1; 277 (1): e162e169e162-e169.

ObjectiveTo systematically review the published literature on the use of prophylactic mesh reinforcement of midline laparotomy closures for prevention of VIH.Summary Of Background DataVIH are common complications of abdominal surgery. Prophylactic mesh has been proposed as an adjunct to prevent their occurrence.MethodsPubMed, Embase, Scopus, and Cochrane were reviewed for RCTs that compared prophylactic mesh reinforcement versus conventional suture closure of midline abdominal surgery. Primary outcome was the incidence of VIH at postoperative follow-up ≥24 months. Secondary outcomes included surgical site infection and surgical site occurrence (SSO). Pooled risk ratios were obtained through random effect meta-analyses and adjusted for publication bias. Network meta-analyses were performed to compare mesh types and locations.ResultsOf 1969 screened articles, 12 RCTs were included. On meta-analysis there was a lower incidence of VIH with prophylactic mesh [11.1% vs 21.3%, Relative risk (RR) = 0.32; 95% confidence interval (CI) = 0.19-0.55, P < 0.001), however, publication bias was highly likely. When adjusted for this bias, prophylactic mesh had a more conservative effect (RR = 0.52; 95% CI = 0.39-0.70). There was no difference in risk of surgical site infection (9.1% vs 8.9%, RR = 1.08, 95% CI = 0.82-1.43; P = 0.118), however, prophylactic mesh increased the risk of SSO (14.2% vs 8.9%, RR = 1.57, 95% CI = 1.19-2.05; P < 0.001).ConclusionCurrent RCTs suggest that in mid-term follow-up prophylactic mesh prevents VIH with increased risk for SSO. There is limited long-term data and substantial publication bias.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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