Efficacy and safety of mesh closure in preventing wound failure following emergency laparotomy: a systematic review and meta-analysis

Aims To evaluate comparative outcomes of emergency laparotomy closure with and without prophylactic mesh. Methods A systematic review was performed via literature databases: PubMed, Cochrane Library, Science Direct, and Google Scholar. Studies were examined for eligibility and included if they compared prophylactic mesh closure to the conventional laparotomy closure following emergency abdominal surgery. Both acute wound failure and incisional hernia (IH) occurence were our primary outcomes. Secondary outcomes included surgical site infection (SSI), seroma/hematoma formation, Clavien-Dindo complications (score >= 3), total operative time, and length of hospital stay (LOS). Results Two randomised controlled trials (RCTs) and four comparative studies with a total of 817 patients met the inclusion criteria. Overall acute wound failure and incisional hernia rate was significantly lower in the mesh group compared to nonmesh group (odd ratio (OR) 0.23, p = 0.002) and (OR 0.21, p = 0.00001), respectively. There was no significant difference between the two groups regarding the following outcomes: total operative time (mean difference (MD) 21.44, p =0.15), SSI (OR 1.47, p = 0.06), seroma/haematoma formation (OR 2.74, p = 0.07), grade >= 3 Clavien-Dindo complications (OR 2.39, p = 0.28), and LOS (MD 0.26, p= 0.84). Conclusion The current evidence for the use of prophylactic mesh in emergency laparotomy is diverse and obscure. Although the data trends towards a reduction in the incidence of IH, a reliable conclusion requires further high-quality RCTs to fully assess the efficacy and safety of mesh use in an emergency setting.

Automated summary

This study evaluated the comparative outcomes of emergency laparotomy closure with and without prophylactic mesh. The results showed that the use of prophylactic mesh significantly reduced the incidence of acute wound failure and incisional hernia. However, there was no significant difference between the two groups in terms of other outcomes such as operative time, infection rate, and complications. The current evidence for the use of prophylactic mesh in emergency laparotomy is diverse and further high-quality studies are needed to fully assess its efficacy and safety.