A Comparative study in elective repair of large incisional hernias using on- lay mesh vs. sub-lay mesh- A Meta-analysis

  1. Philobater Awad
  2. Basma Hussein Abdelaziz Hassan
  3. Kirollos Adel Louiz Kamel

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Abstract

Background: Ventral abdominal wall incisional hernia is defined as a defect in the musculo-fascial layers of the abdominal wall in the region of postoperative scar. There is a slight increase in the incidence of incisional hernia in the female gender. The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also increased incidence of obesity in females. Objective: To assess incisional hernia repair using two different techniques: on-lay mesh and sub-lay mesh, as regards operative time, postoperative recurrence, wound infection, seroma, hematoma and flap necrosis. Patients and Methods: The Pubmed, web of science and Scopus were searched on 15 March, 2022. The keywords incisional hernia, sub-lay mesh on-lay mesh, retromuscular mesh, polypropylene. Results and Conclusion: According to our results, there is a statistical difference between onlay and sublay regarding intra-operative time as sublay mesh is more time consuming. Regarding post-operative complications there is no statistical difference in recurrence, seroma, hematoma, flap necrosis and infection but there is a statistical difference regarding in hospital stay as patients with sublay repair stays less than onlay.

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  1. PeerRef

    Peer review report

    Title: A Comparative study in elective repair of large incisional hernias using on- lay mesh vs. sub-lay mesh- A Meta-analysis

    version: 1

    Referee: Julie Holihan

    Institution: UTHealth at Houston

    email: Julie.L.Holihan@uth.tmc.edu

    ORCID iD: 0000-0001-6764-1687

    General assessment

    This was a systematic review and meta-analysis comparing onlay to sublay mesh placement in incisional hernia repair. Though this is an important topic, the systematic review seems incomplete and the manuscript is poorly written.

    Essential revisions that are required to verify the manuscript

    The introduction does not introduce the paper well. Why is it relevant to the question being asked that incisional hernias are more common in females, or speculations as to why this is the case? The study is looking at mesh location, so the introduction should focus on this. What is known about mesh location, why is it important, etc. Currently, intro sort of seems like a conglomeration of random facts about hernias.

    Overall, needs editing for numerous grammatical errors. Difficult to read.

    The results from search (figure 1) should be referred to in the results section, not the methods. Eligibility criteria is poorly written and unclear.

    I think the search terms used are inadequate. This seems to have missed many studies.

    Were PRISMA guidelines followed? Should be revised to follow PRISMA guidelines. Methods need to be much more transparent.

    It seems incorrect that many of the I2 values are 0. Need to check this with a statistician.

    There are results from a sensitivity analysis reported but the methods section does not describe how this was done.

    The discussion section just seems to be repeating the results. It should be discussing and interpreting them.

    Other suggestions to improve the manuscript

    Tables and figures need better labels.

    Decision

    Requires revisions: The manuscript contains objective errors or fundamental flaws that must be addressed and/or major revisions are suggested.

  2. Version published to 10.21203/rs.3.rs-2511771/v1 on Research Square