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Evidence summaries

Open Surgical Procedures for Incisional Hernias

Open mesh repair of incisional hernias in adults is superior to suture repair in terms of recurrences, but inferior when considering wound infection. Level of evidence: "A"

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.

    References

    • den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW. Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 2008 Jul 16;(3):CD006438 [Review content assessed as up-to-date: 12 October 2010]. [PubMed] .

Primary/Secondary Keywords