Peer-reviewed veterinary case report
Is mesh fixation needed in open ventral hernia repair
By Theis C et al.·2026·Department of Surgery, United States·View original on Europe PMC →
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Original publication title: Is mesh fixation necessary in open retromuscular ventral hernia repair? A meta-analysis.
Plain-English summary
This study looked at a surgical technique called retromuscular ventral hernia repair (RVHR), which involves placing a mesh to support the area where a hernia occurs. Researchers wanted to find out if fixing the mesh in place made a difference in how well the surgery worked and if it caused more problems afterward. They reviewed data from six studies involving over 15,000 patients and found that whether or not the mesh was fixed did not change the chances of the hernia coming back or the level of pain after surgery. However, using mesh fixation was linked to lower quality of life scores and a higher risk of developing hematomas, which are collections of blood outside of blood vessels. Overall, the study suggests that mesh fixation should be used selectively, rather than as a standard practice in this type of surgery.
Abstract
<h4>Purpose</h4>Retromuscular ventral hernia repair (RVHR) is a well-established and increasingly popular technique for mesh placement, offering favorable recurrence and complication rates. However, the role of mesh fixation in RVHR remains unclear, as some have questioned its effect on reducing recurrence and could potentially increase postoperative morbidity. We performed a systematic review and meta-analysis to compare outcomes of RVHR with and without mesh fixation.<h4>Methodology</h4>PubMed, EMBASE, and Cochrane Library were searched through July 2025. Eligible studies included adult patients undergoing open RVHR with or without fixation. Primary outcomes were hernia recurrence and postoperative pain; secondary outcomes included hematoma, seroma, surgical site infection (SSI), reoperation, operative time, length of stay (LOS), and quality of life. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects models were used, and heterogeneity was quantified using the I2 statistic.<h4>Results</h4>Six studies (15,106 patients; 3,994 without fixation) met inclusion criteria: two randomized controlled trials and four observational cohorts, including one registry study. Recurrence did not differ between fixation and non-fixation (OR 1.1, 95% CI 0.91-1.34; I2 = 0%). Fixation was associated with significantly worse quality-of-life scores (MD -12.71, 95% CI -16.48 to -8.93; p < 0.001; I2 = 0%) and higher hematoma risk (OR 5.18, 95% CI 1.18-22.68; p = 0.03; I2 = 0%). No significant differences were found for pain, SSI, seroma, reoperation, LOS, or operative time.<h4>Conclusion</h4>Our systematic review and meta-analysis identified no difference in recurrence, pain, SSI, or long-term outcomes between mesh fixation and non-fixation in RVHR. However, fixation was associated with significantly worse quality-of-life scores and a higher risk of hematoma. These findings suggest a selective rather than routine use of mesh fixation in RVHR.
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Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41543744