We have a long way to go. Invited comment to: A systematic methodological review of reported perioperative variables, postoperative outcomes and hernia recurrence from randomized controlled trials of elective ventral hernia repair: clear definitions and standardized datasets are needed. Samuel G. Parker, C. P. J. Wood, J. W. Butterworth, R. W. Boulton, A. A. O. Plumb, S. Mallett, S. Halligan, A. C. J. Windsor

From the patient’s perspective, a ventral hernia can cause pain, adversely affect function, increase size, cosmetically distort the abdomen, and incarcerate/strangulate abdominal contents. The only known cure for a ventral hernia is surgical repair. The purpose of the current analysis was to review the published randomized controlled trials (RCTs) of the surgical care of ventral hernia. We conducted this meta-analysis using a comprehensive search of EMBASE, MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials till 01 March 2018 for randomized controlled trials on the use of mesh reinforcement in abdominal wall hernia repair. 15 studies met the search criteria, laparoscopic repair (OR 0.59; 95% CI 0.02–6.71) had the highest probability of having the lowest rate of surgical site infection. Among open mesh repair techniques, sublay repair (OR 1.41; 95% CI 0.01–5.99) had the highest probability of being the best treatment. Among patients experiencing ventral hernia repair, mesh reinforcement ought to be used regularly when there is no infection. Sublay mesh might outcome in fewer reappearances and surgical site infections. The quality of evidence to support these recommendations is moderate to high.

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O13 BIOLOGIC VERSUS SYNTHETIC MESH IN VENTRAL HERNIA REPAIR: PARTICIPANT-LEVEL ANALYSIS OF TWO RANDOMIZED CONTROLLED TRIALS AT ONE YEAR

British Journal of Surgery ◽

10.1093/bjs/znab396.012 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Naila Dhanani ◽

Oscar Olavarria ◽

Kyung Hyun Lee ◽

Charlotte Young ◽

Frank Primus ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Major Complication ◽

Synthetic Mesh ◽

Biologic Mesh ◽

P Value ◽

Controlled Trials ◽

Randomized Controlled ◽

One Year

Abstract Aim Biologic mesh has been increasingly utilized in complex ventral hernia repair despite limited evidence at low risk of bias supporting its growth. We hypothesized biologic mesh when compared to synthetic mesh would have fewer major complications at one year. Material and Methods We performed a participant-level meta-analysis of published randomized controlled trials (RCTs) comparing biologic to synthetic mesh at one year. Primary outcome was major complication (composite of mesh infection, recurrence, reoperation, or death) at one year post-operative. Secondary outcomes included length of index hospital stay, surgical site occurrence, and surgical site infection. Outcomes were assessed using frequentist generalized linear models. Results A total of 252 patients from two RCTs were included, 126 patients randomized to the intervention arm of biologic mesh and 126 patients randomized to the control of synthetic mesh. Median follow-up was 15 (12, 27) months. Major complication occurred in 41 (33%) patients randomized to biologic mesh, and 44 (35%) patients randomized to synthetic mesh, (relative risk [RR] 0.91, 95% confidence interval [CI] 0.54-1.55, p-value 0.740). There were 36 total recurrences, 23 (18%) in the biologic arm, and 13 (10%) in the synthetic arm (RR 1.83, 95% CI 0.84-3.99, p-value 0.130). The remainder of outcomes demonstrated no statistically significant differences. Conclusions The risk of major complication did not differ between biologic versus synthetic mesh. In patients undergoing ventral hernia repair, there was no clinical benefit with biologic mesh as opposed to synthetic mesh at one year post-operative.

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Closure Versus Non-Closure of Hernia Defect in Laparoscopic Ventral Hernia Repair with Mesh: A Systematic Review

10.21203/rs.3.rs-803216/v1 ◽

2021 ◽

Author(s):

Emad Aljohani

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Randomized Controlled Trials ◽

Ventral Hernia ◽

Observational Studies ◽

Fascial Closure ◽

Controlled Trials ◽

Patient’S Satisfaction ◽

Randomized Controlled

Abstract PurposeThere is a controversial premise about choosing a surgical approach in ventral hernia using laparoscopic repair. Some surgeons prefer to use mesh with closure while others prefer to use mesh without closure. This study aims to compare mainly the rate of recurrence in mesh repair with and without closure. MethodsA wide range of electronic bibliographic databases such as PubMed, Embase, and ERIC was searched. Based on the eligibility criteria, all studies which compared the results after hernia repair from 2010 to 2020, were incorporated. Following screening the abstracts, we ended up reviewing seven full-text articles, and data were extracted on important parameters such as demographic attributes of participants, sample size, and recurrence rate of hernia.ResultsOf the total studies that were reviewed, three were randomized controlled trials (RCT’s) and four retrospective observational studies. The sample size of all included studies varied between 80 to 176. The findings appear promising for the fascial closure as it showed an evidence of significant reduction in the recurrence rate with P = 0•047 in one out of the three RCT’s and in the retrospective observational studies reaching up to 16.7 % recurrence reduction rate. Likewise, there is also a reduction in the bulging, surgical site infection and seroma formation with higher patient’s satisfaction and quality of life score.ConclusionPrimary fascial closure appears to be effective as it can decrease the rates of recurrence, seroma formation, bulging and improve patient’s satisfaction and quality of life. Given the dearth of studies, mainly randomized controlled trials, there is a need to carry out large randomized controlled trials with enough follow-up.

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Closure Versus Non-closure of Hernia Defect in Laparoscopic Ventral Hernia Repair with Mesh: a Systematic Review

Indian Journal of Surgery ◽

10.1007/s12262-021-03203-4 ◽

2021 ◽

Author(s):

Emad Aljohani

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Randomized Controlled Trials ◽

Ventral Hernia ◽

Observational Studies ◽

Fascial Closure ◽

Controlled Trials ◽

Patient’S Satisfaction ◽

Randomized Controlled

AbstractThere is a controversial premise about choosing a surgical approach in ventral hernia using laparoscopic repair. Some surgeons prefer to use mesh with closure while others prefer to use mesh without closure. This study aims to compare mainly the rate of recurrence in mesh repair with and without closure. A wide range of electronic bibliographic databases such as PubMed, Embase and Education Resources Information Center (ERIC) was searched. Based on the eligibility criteria, all studies which compared the results after hernia repair from 2010 to 2020 were incorporated. Following screening the abstracts, we ended up reviewing seven full-text articles, and data were extracted on important parameters such as demographic attributes of participants, sample size and recurrence rate of hernia. Of the total studies that were reviewed, three were randomized controlled trials (RCT’s) and four retrospective observational studies. The sample size of all included studies varied between 80 and 176. The findings appear promising for the fascial closure as it showed evidence of a significant reduction in the recurrence rate with P = 0.047 in one out of the three randomized controlled trials and in the retrospective observational studies reaching up to 16.7% recurrence reduction rate. Likewise, there is also a reduction in the bulging, surgical site infection and seroma formation with higher patient’s satisfaction and quality of life score. Primary fascial closure appears to be effective as it can decrease the rates of recurrence, seroma formation and bulging, and improve patient’s satisfaction and quality of life. Given the dearth of studies, mainly randomized controlled trials, there is a need to carry out large randomized controlled trials with enough follow-up.

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Robotic versus Laparoscopic Ventral Hernia Repair: A Multicenter, Blinded Randomized Controlled Trial

SSRN Electronic Journal ◽

10.2139/ssrn.3453330 ◽

2019 ◽

Author(s):

Oscar Olavarria ◽

Karla Bernardi ◽

Shinil K. Shah ◽

Todd D. Wilson ◽

Shuyan Wei ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Controlled Trial ◽

Laparoscopic Ventral Hernia Repair ◽

Randomized Controlled

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Total extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials

Hernia ◽

10.1007/s10029-021-02407-7 ◽

2021 ◽

Author(s):

Alberto Aiolfi ◽

Marta Cavalli ◽

Simona Del Ferraro ◽

Livia Manfredini ◽

Francesca Lombardo ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Randomized Controlled Trials ◽

Sequential Analysis ◽

Hernia Recurrence ◽

Trial Sequential Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Transabdominal Preperitoneal ◽

Tapp Repair

Abstract Purpose To examine the updated evidence on safety, effectiveness, and outcomes of the totally extraperitoneal (TEP) versus the laparoscopic transabdominal preperitoneal (TAPP) repair and to explore the timely tendency variations favoring one treatment over another. Methods Systematic review and trial sequential analysis (TSA) of randomized controlled trials (RCTs). MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were consulted. Risk Ratio (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were used as pooled effect size measures. Results Fifteen RCTs were included (1359 patients). Of these, 702 (51.6%) underwent TAPP and 657 (48.4%) TEP repair. The age of the patients ranged from 18 to 92 years and 87.9% were males. The estimated pooled RR for hernia recurrence (RR = 0.83; 95% CI 0.35–1.96) and chronic pain (RR = 1.51; 95% CI 0.54–4.22) were similar for TEP vs. TAPP. The TSA shows a cumulative z-curve without crossing the monitoring boundaries line (Z = 1.96), thus supporting true negative results while the information size was calculated as adequate for both outcomes. No significant differences were found in term of early postoperative pain, operative time, wound-related complications, hospital length of stay, return to work/daily activities, and costs. Conclusions TEP and TAPP repair seems comparable in terms of postoperative hernia recurrence and chronic pain. The cumulative evidence and information size are sufficient to provide a conclusive evidence on recurrence and chronic pain. Similar trials or meta-analyses seem unlikely to show diverse results and should be discouraged.

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