A Cochrane review [Abstract] 1 included 7 studies with a total of 1 141 subjects. Hernia recurrence was more frequent (RR 1.85, 95% CI 1.33 to 2.56; 3 studies, n=445), wound infection less frequent (RR 0.09, 95% CI 0.01 to 0.70, 2 studies, n=198) in the direct suture group compared to the onlay or sublay mesh groups. For every six mesh repairs, one recurrence is prevented in comparison with direct suture repair, but one infection is seen for every 10 mesh repairs. Different hernia sizes in the included studies are a source of clinical heterogeneity. There is insufficient evidence from five trials in this review as to which type of mesh or which position of the mesh (on- or sublay) should be used in open ventral hernia repair. Also, insufficient evidence was found to advocate the use of the components separation technique.
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