Peritoneal flap hernioplasty for large ventral hernias: a systematic review and meta-analysis

Primary closure of large ventral hernia is difficult and is usually complicated by postoperative mesh bulge, migration, and higher recurrence. Techniques like component separation and bridging mesh, transversus abdominus release, da Silva triple-layer repair, and peritoneal flap hernioplasty (PFH) are common treatment options.

To evaluate the early postoperative and long-term outcomes of PFH for large ventral hernias.

A systematic literature search was performed on the electronic databases of PubMed, Web of Knowledge, and Scopus till July 28, 2024. We performed a single-arm meta-analysis of non-comparative studies using OpenMeta[Analyst] software (Center for Evidence-Based Medicine, Brown University, Rhode Island, USA).

Five studies including 432 patients (238 male and 194 female patients in a ratio of 1.23:1.0) underwent PFH for large ventral hernia. The estimated proportion of patients who may experience skin necrosis, seroma, hematoma, superficial surgical site infection, and deep mesh infection were 1.2% (95% CI: 0.001, 0.022; I²: 0.53%) 5.8% (95% CI: 0.036, 0.080; I²: 0%), 3.7% (95% CI: 0.007, 0.067; I²: 59.32%), 10.6% (95% CI: 0.077, 0.135; I²: 0%), and 0.9% (95% CI: -0.004, 0.022; I²: 15.99%) respectively. Similarly, the estimated recurrence rate and chronic pain following PFH was 1.9% (95% CI: 0.005, 0.033; I²: 2%) and 11.6% (95% CI: 0.032, 0.200; I²: 83.43%) respectively during the mean follow-up time of 33 months (95% CI: 1.9, 64.1).

PFH seems to be a safe and feasible procedure for the repair of complex or large ventral hernias where it is difficult to perform primary fascial closure. Further studies with a direct comparison of PFH with component separation techniques are necessary to validate the results of our study.