A Systematic Review and Meta-Analysis of Randomized Controlled Trials on Fascial Defect Closure Versus Bridged Repair in Laparoscopic Ventral Hernia Mesh Repair.

Abstract

<h4>Introduction</h4>This study compares the outcomes in patients undergoing ventral hernia repair using intraperitoneal underlay mesh (IPUM) without facial defect closure versus intraperitoneal underlay mesh following fascial defect closure (IPUM+).<h4>Methods</h4>To search for randomized controlled trials comparing outcomes of patients with ventral hernias who were managed surgically with either IPUM or IPUM+, standard medical databases such as MEDLINE, Embase, PubMed, and Cochrane Library were used, covering studies published up to and including September 2025. The meta-analysis was performed with a random effect model analysis, and all data was analyzed using Review Manager Software 5.4.<h4>Results</h4>Five randomized controlled trials (n = 549) were included, involving adult patients who underwent laparoscopic ventral hernia repair with IPUM or IPUM+. The pooled analysis showed no significant difference in hernia recurrence (Risk Ratio [RR]: 0.82, 95% CI: [0.29, 2.27], p = 0.70), seroma formation (RR: 0.78, 95% CI: [0.32, 1.88], p = 0.58), operating times (Standard Mean Difference [SMD]: 0.26, 95% CI [-0.17, 0.69], p = 0.23) and pain scores (SMD: 0.26, 95% CI [-0.17, 0.69], p = 0.23) between the two approaches.<h4>Conclusion</h4>IPUM and IPUM+ are both associated with similar postoperative morbidities for the treatment of ventral hernia repair.