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)
Abstract
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…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 617 participants or records.
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