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Intraperitoneal versus extraperitoneal mesh in minimally invasive ventral hernia repair: a systematic review and meta-analysis

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Abstract

Purpose

The ideal location for mesh placement in minimally invasive ventral hernia repair (VHR) is still up for debate. We undertook a systematic review and meta-analysis (SRMA) to evaluate the outcomes of patients who received intraperitoneal mesh versus those that received extraperitoneal mesh in minimally invasive VHR.

Methods

We searched PubMed, EMBASE, Cochrane, and Scopus from inception to May 3, 2021. We selected studies comparing intraperitoneal mesh versus extraperitoneal mesh placement in minimally invasive VHR. A meta-analysis was done for the outcomes of surgical site infection (SSI), seroma, hematoma, readmission, and recurrence. A subgroup analysis was conducted for a subset of studies comparing patients who have undergone intraperitoneal onlay mesh (IPOM) versus extended totally extraperitoneal approach (e-TEP).

Results

A total of 11 studies (2320 patients) were identified. We found no statistically significant difference between patients who received intraperitoneal versus extraperitoneal mesh for outcomes of SSI, seroma, hematoma, readmission, and recurrence [(RR 1.60, 95% CI 0.60–4.27), (RR 1.39, 95% CI 0.68–2.81), (RR 1.29, 95% CI 0.45–3.72), (RR 1.40, 95% CI 0.69–2.86), and (RR 1.22, 95% CI 0.22–6.63), respectively]. The subgroup analysis had findings similar to the overall analysis.

Conclusion

Based on short-term results, extraperitoneal mesh does not appear to be superior to intraperitoneal mesh in minimally invasive ventral hernia repair. The choice of mesh location should be based on the current evidence, surgeon, and center experience as well as individualized to each patient.

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Data availability

Data may be made available upon reasonable request.

Code availability

Code may be made availability upon reasonable request.

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Funding

This study was not funded.

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    M. Yeow

  2. Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    S. Wijerathne & D. Lomanto

  3. Department of Surgery, Alexandra Hospital, Singapore, Singapore

    S. Wijerathne

  4. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    D. Lomanto

Authors
  1. M. Yeow
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  2. S. Wijerathne
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  3. D. Lomanto
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Contributions

All authors made substantial contributions to the conception of the work, the acquisition, analysis, interpretation of data, drafted the work, and revised it critically for important intellectual content, approved the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to D. Lomanto.

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Yeow, M., Wijerathne, S. & Lomanto, D. Intraperitoneal versus extraperitoneal mesh in minimally invasive ventral hernia repair: a systematic review and meta-analysis. Hernia 26, 533–541 (2022). https://doi.org/10.1007/s10029-021-02530-5

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  • DOI: https://doi.org/10.1007/s10029-021-02530-5

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