The safety of polypropylene mesh in repairing incarcerated or strangulated hernias with organ resection.

backgroundOrgan resection is often required in incarcerated or strangulated hernias, which makes the surgical field more contaminated, and increased contamination makes it possible to elevate the risk of surgical site infections and increase the likelihood of hernia recurrence. The safety of polypropylene mesh for repair in such contaminated conditions is equivocal, leading to controversy concerning its application. This study aims to elucidate this matter by comparing the complications between mesh repair and primary repair specifically in strangulated or incarcerated hernias with organ resection. At the same time, the study contributed to assessing the safety of polypropylene mesh in repairing hernias under conditions where infection is a significant concern.

methodsThis meta-analysis was reported following PRISMA 2020 guidelines, all studies were searched and retrieved from major databases (PubMed, and Web of Science), and were included if they reported complications between mesh repair and primary repair in incarcerated or strangulated ventral or groin hernias with or without organ resection. Meta-analyses were conducted when possible, and subgroup analyses were made for the severity of complications (major vs minor) and hernia type (ventral vs. groin). According to the study design, the risk of bias was assessed using the Newcastle-Ottawa Scale. All related articles and reference lists in these original studies were also obtained from the above databases.

resultsNine observational studies containing 1287 patients with incarcerated or strangulated hernias were included. Three findings were found: (1) Overall complications in the mesh repair group were more than those in the primary repair group in incarcerated or strangulated hernias with organ resection (OR = 4.93; 95% CI: 2.54, 9.56; P < 0.00001). (2) There was a slight tendency for more complications to occur in the organ resection group than in the non-resection group with mesh repair, although the difference was subtle (OR = 3.36; 95% CI: 0.86, 13.15; P = 0.08). (3) There was a trend that more complications occurred when mesh was used in emergent ventral hernia repair than in primary repair (OR = 3.33; 95% CI: 0.91, 12.26; P = 0.07), while, this trend was not observed in emergent groin hernia repair.

conclusionIn cases of incarcerated or strangulated hernias requiring organ resection, the use of polypropylene mesh has been correlated with a higher incidence of complications compared to primary repair. Additionally, a trend was observed toward greater complication rates when ventral hernia repair was performed. Therefore, polypropylene mesh should be used cautiously in strangulated hernias with organ resection or in the repair of the ventral hernia.