Peer-reviewed veterinary case report
Retromuscular mesh to prevent hernias after midline laparotomy
By Lagger M et al.·2025·Department of Surgery·View original on Europe PMC →
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Original publication title: Retromuscular prophylactic mesh reinforcement after midline laparotomy: a systematic review and meta-analysis.
Plain-English summary
Incisional hernias, which are bulges that can occur after surgery, are a common problem following a type of surgery called laparotomy. This study looked at whether placing a special mesh in the retromuscular area (the space behind the muscles) during surgery can help prevent these hernias, especially in both planned and emergency surgeries. Researchers reviewed eight studies involving over 1,100 patients and found that using this mesh significantly lowered the chances of developing an incisional hernia compared to just stitching the incision closed. However, the results varied quite a bit between studies, and while there were no major increases in infections, there were some signs that using the mesh might lead to more fluid buildup or bleeding in some cases. Overall, using retromuscular mesh appears to be effective in reducing hernias after elective surgery, especially with synthetic mesh, but more research is needed for emergency situations.
Abstract
<h4>Purpose</h4>Incisional hernias (IH) are a frequent complication after laparotomy, contributing to patient morbidity and increased healthcare costs. While guidelines recommend prophylactic mesh reinforcement (PMR) in high-risk elective surgeries, there are no specific recommendations for contaminated/emergency settings. The retromuscular plane is considered optimal for mesh placement due to its favourable outcomes. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of retromuscular PMR in reducing IH rates following elective and contaminated/emergency midline laparotomies.<h4>Methods</h4>Following the PICO framework, we included studies assessing patients undergoing elective or contaminated/emergency midline laparotomies. The intervention was retromuscular PMR compared to primary suture closure (PSC). The primary outcome was IH incidence, with surgical site infection (SSI), seroma, and hematoma as secondary outcomes. A systematic literature search was conducted in Medline, Embase, Web of Science and Cochrane Library, the last search was completed on March 7th, 2025. Risk of bias was assessed using the RoB 2 tool. A random-effects meta-analysis was performed, with subgroup analyses by mesh type and surgical setting.<h4>Results</h4>Eight randomized controlled trials totalizing 1167 patients were included. PMR significantly reduced the risk of incisional hernia at the longest available follow-up compared to primary suture closure (OR 0.37, 95% CI 0.17-0.80), but heterogeneity was high (I<sup>2</sup> = 74%). Subgroup analysis showed benefit with synthetic mesh (OR 0.18, 95% CI 0.06-0.52) but not with biologic mesh. No significant differences were observed in surgical site infection, while non-significant trends toward increased seroma (OR 1.97) and hematoma (OR 3.05) were noted. Evidence in contaminated/emergency settings was limited and exploratory.<h4>Conclusion</h4>Retromuscular prophylactic mesh reinforcement reduces incisional hernia incidence in elective laparotomy, particularly with synthetic mesh, without increasing major infectious complications. However, substantial heterogeneity across studies limits the certainty of effect estimates, and evidence in contaminated or emergency surgery remains insufficient.<h4>Systematic review registration</h4>PROSPERO CRD42025632413.
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Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41454018