Background: Incisional hernia (IH) remains one of the most frequent postoperative complications after abdominal surgery. As a consequence, primary mesh augmentation (PMA), a technique to strengthen the abdominal wall, has been gaining popularity. This meta-analysis was conducted to evaluate the prophylactic effect of PMA on the incidence of IH compared to primary suture (PS). Methods: A meta-analysis was conducted according to the PRISMA guidelines. Randomized controlled trials (RCTs) comparing PMA and PS for closing the abdominal wall after surgery were included. Results: Out of 576 papers, 5 RCTs were selected comprising 346 patients. IH occurred significantly less in the PMA group (RR 0.25, 95% CI 0.12-0.52, I20%; p < 0.001). No difference could be observed with regard to wound infection (RR 0.86, 95% CI 0.39-1.91, I2 0%; p = 0.71) or seroma (RR 1.22, 95% CI 0.64-2.33, I2 0%; p = 0.55). A trend was observed for chronic pain in favor of the PS group (RR 5.95, 95% CI 0.74-48.03, I20%; p = 0.09). Conclusion: The use of PMA for abdominal wall closure is associated with significantly lower incidence of IH compared to PS.

Abdominal wall closure, Incisional hernia, Primary mesh augmentation, Primary suture,
Digestive Surgery
Department of Surgery

Timmermans, L, de Goede, B, Eker, H.H, van Kempen, B.J.H, Jeekel, J, & Lange, J.F. (2014). Meta-analysis of primary mesh augmentation as prophylactic measure to prevent incisional hernia. Digestive Surgery (Vol. 30, pp. 401–409). doi:10.1159/000355956