Mesh Suture and Mesh Strips to Prevent Incisional Hernia Following Abdominal Wall Closure or Ventral Hernia Repair: Systematic Review.

Background: Mesh suture, or Duramesh™, has recently gained attention because of potential advantages over conventional techniques for abdominal wall closure. However, the evidence base for any advantage has not been assessed formally. Via systematic review we evaluated clinical outcomes for mesh suture and its precursor, mesh strip, in clinical trials of abdominal wall closure or ventral hernia repair. Methods: A systematic search of MEDLINE, CENTRAL, Embase, Cochrane, WHO International Clinical Trials Registry, and ClinicalTrials.gov was conducted to identify studies using mesh suture and/or mesh strip. Primary outcome was incisional hernia occurrence after primary closure or recurrence following ventral hernia repair, summarised with median percentage rates. Secondary outcomes included surgical site occurrences and reoperations. Risk of bias was assessed using adapted forms of ROBINS-I and Cochrane RoB2 tools. Results: Five single-arm case series and one interim report from a randomised controlled trial were eligible for inclusion, reporting 585 patients. Median follow-up was 11.9 months (range 2.7-35.3 months). Median incisional hernia occurrence was 3.4% (range 0%-50%). Median surgical site occurrence was 17.4% (range 0%-50%) and surgical site infection 5.4% (range 0%-19%). Overall, 6.0% patients (33 of 553) returned to theatre to manage complications. Overall risk of bias for included studies was critical. Conclusion: This systematic review highlights a need for high-quality randomised controlled trials with long-term follow-up to evaluate the clinical benefits of Duramesh™ for abdominal wall closure and ventral hernia repair. Better evidence is required to determine its safety and clinical efficacy.