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Original Investigation | Association of VA Surgeons

Comparison of Outcomes of Synthetic Mesh vs Suture Repair of Elective Primary Ventral Herniorrhaphy:  A Systematic Review and Meta-analysis

Mylan T. Nguyen, MS1; Rachel L. Berger, BA2; Stephanie C. Hicks, PhD3; Jessica A. Davila, PhD4; Linda T. Li, MD2; Lillian S. Kao, MD1; Mike K. Liang, MD1
[+] Author Affiliations
1Department of Surgery, The University of Texas Health Sciences Center, Houston, Texas
2Department of Surgery, Baylor College of Medicine, Houston, Texas
3Department of Statistics, Dana Farber Cancer Institute, Boston, Massachusetts
4Houston Veterans Affairs Health Services Research and Development Center for Excellence, Baylor College of Medicine, Houston Texas
JAMA Surg. 2014;149(5):415-421. doi:10.1001/jamasurg.2013.5014.
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Published online

Importance  More than 350 000 ventral hernias are repaired in the United States annually, of which 75% are primary ventral hernias (eg, umbilical or epigastric hernias). Despite the volume, there is insufficient evidence to support the use of sutures vs mesh for primary ventral hernia repairs.

Objective  To compare suture vs mesh repairs for 3 outcomes: hernia recurrence, surgical site infection (SSI), and seromas.

Data Sources  Randomized controlled trials, case-control, and cohort studies were identified from OVID, PubMed, and reference lists from January 1, 1980, through June 1, 2012.

Study Selection  English-language studies with adult patients were eligible for review if there was mention of both suture and mesh techniques used during elective repair of a primary ventral hernia. Two study authors independently reviewed the 1492 articles originally identified and selected 9 for analysis. The Downs and Black 26-item checklist was used to critically assess the risk of bias.

Data Extraction  Year of publication, study design, inclusion and exclusion criteria, number of patients, follow-up duration, use of preoperative antibiotics, size of hernias repaired, age, body mass index (calculated as weight in kilograms divided by height in meters squared), American Society of Anesthesiologists grade, repair techniques, incidence of hernia recurrence, seroma, and SSI.

Data Extraction and Synthesis  Three separate univariate meta-analyses for each end point followed by a multivariate meta-analysis were performed. Across all 9 studies, there were 637 mesh repairs and 1145 suture repairs. The pooled mesh repairs demonstrated a 2.7% recurrence rate, 7.7% seroma rate, and 7.3% SSI rate The pooled suture repairs demonstrated an 8.2% recurrence rate, 3.8% seroma rate, and 6.6% SSI rate. On the basis of results from the multivariate meta-analysis, recurrences (log odds ratio , −1.04; 95% CI, −1.58 to −0.52) were more common with suture repair, whereas seromas (0.84; 0.27-1.41) and SSIs (0.65; 0.12-1.18) were more common with mesh repair.

Conclusions and Relevance  Mesh repair has a small reduction in recurrence rates compared with suture repairs for primary ventral hernias, but an increased risk of seroma and SSI was observed. Further high-quality studies are necessary to determine whether suture or mesh repair leads to improved outcomes for primary ventral hernias.

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Systematic Literature Search Flowchart

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Figure 2.
Associations Between Outcome and Repair Type

A, Hernia recurrence; B, seroma; C, surgical site infection. OR indicates odds ratio.

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