Fascial Defect Closure During Ventral Hernia Repair: A Systematic Review of Randomized Controlled Trials

Authors

Shin Jeong, HCA Houston Healthcare KingwoodFollow
Tunmi A. Anwoju, HCA Healthcare Graduate Medical EducationFollow
Oscar A. Olavarria, McGovern Medical SchoolFollow
Natalia Cavagnaro, HCA Houston Healthcare KingwoodFollow
Naila H. Dhanani, McGovern Medical SchoolFollow
Nicole B. Lyons, University of Miami Miller School of MedicineFollow
Zuhair Ali, HCA Healthcare Graduate Medical EducationFollow
Mike K. Liang, HCA Houston Healthcare KingwoodFollow

Keywords

fascial closure; bridged hernia repair; operative surgical procedures; ventral hernia; surgical wound infection; intraoperative complications; randomized controlled trial; systematic review

Disciplines

Surgery

Abstract

Background

During minimally invasive ventral hernia repair (VHR) it is unknown if a fascial defect closure, as opposed to a bridged repair (current care), is beneficial for patients. We sought to systematically review the published literature on the role of fascial defect closure during minimally invasive VHR.

Methods

PubMed, Embase, Scopus, Cochrane, and Clinicaltrials.gov were reviewed for randomized controlled trials (RCTs) that compared fascial defect closure with bridged repair. The primary outcome was major complications defined as deep/organ-space surgical site infections (SSIs), reoperations, hernia recurrences, or deaths. Secondary outcomes included SSI, seroma, eventration, hernia recurrence, post-operative pain, and quality of life (QOL). Pooled risk ratios with 95% confidence intervals were obtained through random effect meta-analyses.

Results

Of 579 screened articles, 6 publications of 5 RCTs were included. No significant difference in major complications (10.6% vs 10.4%, RR=1.05, 95% CI=0.51-2.14, P=.90) or recurrences (9.0% vs 10.6%, RR=0.92, 95% CI=0.32-2.61, P=.87) were found between groups. Fascial defect closure decreased the risk of seromas (22.9% vs 34.2%, RR=0.60, 95% CI=0.37-0.97, P=.04) and may decrease the risk of eventrations (6.7% vs 9.0%, RR=0.74, 95% CI=0.37-1.50, P=.41) at the expense of potentially increasing the risk of SSI (3.2% vs 1.4%, RR=1.89, 95% CI=0.60-5.93; P=.28). Reporting of pain and QOL scores was inconsistent.

Conclusion

While most individual RCTs demonstrated benefit with fascial defect closure during minimally invasive VHR, our meta-analysis of fascial defect closure demonstrated only a statistically significant difference in seromas compared to bridged repair. Large, multi-center RCTs are needed.

Recommended Citation

Jeong, Shin; Anwoju, Tunmi A.; Olavarria, Oscar A.; Cavagnaro, Natalia; Dhanani, Naila H.; Lyons, Nicole B.; Ali, Zuhair; and Liang, Mike K. (2023) "Fascial Defect Closure During Ventral Hernia Repair: A Systematic Review of Randomized Controlled Trials," HCA Healthcare Journal of Medicine: Vol. 4: Iss. 4, Article 2.
DOI: 10.36518/2689-0216.1469
Available at: https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol4/iss4/2