Mending the Gap: A Systematic Review and Meta-Analysis of Mesh Reinforcement for Abdominal Wall Closure in Abdominal Aortic Aneurysm (AAA) Repair.

Abstract

Incisional hernias are a common complication following abdominal aortic aneurysm (AAA) repair, leading to significant morbidity, higher healthcare costs, and reduced quality of life. While mesh reinforcement is widely used in abdominal surgery, its role in AAA repair remains uncertain due to limited evidence from randomised controlled trials (RCTs) and ongoing concerns about postoperative complications such as infection and seroma formation. A systematic review and meta-analysis of RCTs evaluated the effectiveness of mesh for primary abdominal wall closure post-AAA repair. Comprehensive searches were conducted in MEDLINE, Cochrane, Cumulative Index of Nursing and Allied Health Literature (CINAHL), National Health Service (NHS) National Electronic Library for Health, and PubMed, with no restrictions on date, language, or publication status. Primary outcomes included incisional hernia rates, reoperation rates, infection rates, and seroma formation rates. Statistical analyses utilised random-effects models, reporting odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic. Mesh reinforcement significantly reduced the risk of incisional hernias by 87% (OR: 0.13; 95% CI: 0.04-0.46; p=0.001). However, seroma formation was over seven times more likely in the mesh group (OR: 7.13; 95% CI: 1.74-29.28; p=0.006). Infection rates were comparable (OR: 2.59; 95% CI: 0.30-22.24; p=0.39), while reoperation rates were lower but not statistically significant (OR: 0.72; 95% CI: 0.21-2.43; p=0.6). Mesh reinforcement provides a clear benefit in significantly reducing incisional hernias post-AAA repair but increases seroma risk. Surgical decision-making should weigh these benefits against the potential harms. Future research should not only assess long-term outcomes but also establish the optimal mesh material, placement technique, and patient selection criteria to maximise benefits while minimising complications.