Evidence map›Paper›PMID 39001938›Full record

SynthesisHernia : the journal of hernias and abdominal wall surgery2024

Mesh versus suture for elective primary umbilical hernia open repair: a systematic review and meta-analysis.

Ana Caroline Dias Rasador, Carlos André Balthazar da Silveira, Diego Laurentino Lima, Raquel Nogueira, Flavio Malcher, Prashanth Sreeramoju, Leandro T Cavazzola

Erratum issued Registry-linked trialAbstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Hernia : the journal of hernias and abdominal wall surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT07156188 (The PAPYRUS Study), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07156188 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

The PAPYRUS Study: Permanent vs. Absorbable Sutures in PrimarY Repair of Umbilical HerniaS: A Multicentre, Single-blind, Non-inferiority, Randomized Controlled Trial

TypeinterventionalSponsorUniversity of British ColumbiaRan2026 to 2030Enrolled914ConditionsHernia Surgery, Umbilical Hernia RepairArmsPermanent Suture, Absorbable
3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Trial
  2. Trial
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Ana Caroline Dias RasadorBahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Brotas, BA, 40290-000, Brazil.
Carlos André Balthazar da SilveiraBahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Brotas, BA, 40290-000, Brazil.
Diego Laurentino LimaDepartment of Surgery, Montefiore Medical Center, 1825 Eastchester Rd, Bronx, NY, 10461, USA. dilaurentino@gmail.com.ORCID 0000-0001-7383-1284
Raquel NogueiraDepartment of Surgery, Montefiore Medical Center, 1825 Eastchester Rd, Bronx, NY, 10461, USA.
Flavio MalcherDivision of General Surgery, NYU Langone, New York, NY, USA.
Prashanth SreeramojuBahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Brotas, BA, 40290-000, Brazil.
Leandro T CavazzolaDepartment of Surgery, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeRecent guidelines indicate the use of mesh in UHR for defects > 1 cm, as it reduces recurrence, with 10% recurrence rate compared to up to 54.5% with primary closure. However, Nguyen et al. shows that primary closure is still widely performed in UHR, especially for small defects (1-2 cm), for which there is no published data to determine the optimal approach. In addition, previous meta-analysis by Madsen et al. comparing mesh repair with primary closure in UHR didn't exclude emergency conditions and recurrent hernias; also, didn't report subgroup analysis on hernia defect size. Thus, we aimed to perform a systematic review and meta-analysis comparing the mesh repairs vs. primary closure of the defect in an open elective primary UHR.

methodsWe searched for studies comparing mesh with suture in open UHR in PubMed, Scopus, Cochrane, Scielo, and Lilacs from inception until October 2023. Studies with patients ≤ 18 years old, with recurrent or emergency conditions were excluded. Outcomes were recurrence, seroma, hematoma, wound infection, and hospital length of stay. Subgroup analysis was performed for: (1) RCTs only, and (2) hernia defects smaller than 2 cm. We used RevMan 5.4. for statistical analysis. Heterogeneity was assessed with I² statistics, and random effect was used if I² > 25%.

results2895 studies were screened and 56 were reviewed. 12 studies, including 4 RCTs, 1 prospective cohort, and 7 retrospective cohorts were included, comprising 2926 patients in total (47.6% in mesh group and 52.4% in the suture group). Mesh repair showed lower rates of recurrence in the overall analysis (RR 0.50; 95% CI 0.31 to 0.79; P = 0.003; I

conclusionThe use of mesh during UHR is associated with significantly lower incidence of recurrence in a long-term follow-up compared to the suture repair, reinforcing the previous indications of the guidelines. Additionally, despite the overall analysis showing higher risk of seroma and wound infection for the mesh repair, no differences were seen after subgroup analysis of RCTs. STUDY REGISTRATION: A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024476854).

Indexed as

Elective Surgical ProceduresHernia, UmbilicalHerniorrhaphySurgical MeshSuture TechniquesHumansRecurrenceMeshParaumbilical herniaSutureUmbilical hernia repair

Identifiers

PMID39001938

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.