SynthesisHernia : the journal of hernias and abdominal wall surgery2026
Prophylactic mesh reinforcement at emergency midline laparotomy: a systematic review and meta-analysis with pre-specified subgroup analysis of contaminated and dirty abdominal wounds (CDC Class III-IV).
Synthesis in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo evaluate the efficacy and safety of prophylactic mesh reinforcement (PMR) at the closure of emergency midline laparotomy (EML), with a pre-specified subgroup analysis of contaminated and dirty wounds (CDC class III-IV).
methodsPRISMA 2020-compliant review (PROSPERO CRD420261324766; OSF 10.17605/OSF.IO/ZX2BG; amendments registered before data extraction). PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus and Web of Science were searched (January 2015-March 2026). RCTs and comparative cohort studies reporting incisional hernia (IH) at ≥ 12 months were eligible; bias was assessed with ROB-2/ROBINS-I. Random-effects meta-analysis used the REML estimator with Hartung-Knapp-Sidik-Jonkman correction. A pre-specified Borenstein interaction test compared CDC class I-II with III-IV; trial sequential analysis (TSA) and GRADE were applied.
resultsFive studies (4 RCTs; 1 cohort; n = 617) were included. PMR was associated with a reduction in IH (pooled OR 0.221, 95% CI 0.122-0.402 [Knapp-Hartung]; 0.101-0.483 under the conservative truncated variant; I2 = 0%); because control-arm event rates exceeded 10%, this corresponds to an approximate RR of ~ 0.36 (0.28-0.38). The RCT-only analysis was concordant (OR 0.179, 95% CI 0.074-0.435). TSA gave an accrued information size of 617 versus a required ~ 151 (409%), interpreted only as numerical sufficiency, not firm evidence. The CDC interaction was non-significant and underpowered (z = 0.327, p = 0.743). Seroma was significantly increased (k = 4; OR 3.980, 95% CI 1.924-8.234; 1.06-14.94 under the conservative variant), whereas deep SSI was non-significant and underpowered (OR 0.991). GRADE: LOW to VERY LOW.
conclusionPMR at EML closure was associated with a consistent IH reduction across CDC classes; however, contaminated-wound evidence is sparse, the subgroup interaction is exploratory, non-significant and underpowered, and the safety profile - particularly deep SSI - remains uncharacterized. Seroma was significantly increased. Given LOW-VERY LOW certainty, these hypothesis-generating findings should not change practice and support an adequately powered multicentre RCT in CDC class III-IV wounds.
trial registrationPROSPERO CRD420261324766 (registered 23 February 2026); OSF Registries https://doi.org/10.17605/OSF.IO/ZX2BG .
Indexed as
Identifiers
What OpenQuestion holds
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.