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Purpose <p>To 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).</p> Methods <p>PRISMA 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&#xa0;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.</p> Results <p>Five 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 (<i>k</i> = 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.</p> Conclusion <p>PMR 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.</p> <p>Trial registration: PROSPERO CRD420261324766 (registered 23 February 2026); OSF Registries<a href="https://doi.org/10.17605/OSF.IO/ZX2BG">https://doi.org/10.17605/OSF.IO/ZX2BG</a>.</p>

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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)

  • 期刊论文

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  • 发表日期：

    2026年7月31日

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  • Ricardo Antonio Gonzalez Jaramillo,
  • Lorena I. Avendaño,
  • Andrea Melissa Briceño González,
  • Brandon Durán Suárez,
  • Jorge Luis Rosales Becerra,
  • Eduardo Jordan Garcia,
  • Carlos Javier Mata Quintero

摘要

Purpose

To 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).

Methods

PRISMA 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.

Results

Five 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.

Conclusion

PMR 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 registration: PROSPERO CRD420261324766 (registered 23 February 2026); OSF Registrieshttps://doi.org/10.17605/OSF.IO/ZX2BG.