Background
Methods
Protocol
Search strategy
Inclusion and exclusion criteria
Quality assessment
Evidence grading
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Evidence grade I: strong scientific evidence based on at least 2 studies with high evidential value or a systematic review/meta-analysis with high evidential value
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Evidence grade II: moderate scientific basis: a study with high evidential value and at least 2 studies with moderate evidential value
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Evidence grade III: low scientific evidence: a study with high evidential value or at least 2 studies with moderate evidence value
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Evidence grade IV: insufficient scientific evidence: 1 study with moderate evidence and/or at least 2 studies with low evidential value
Risk of bias within and across studies
Results
Citation selection and characteristics
Author (year) and journal | Study type, patients and data years1 | Objective | Technique | Type of mesh | Findings/complications | Follow-up | Q S/E G2 |
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Sugerman et al. (1996) THE AMERICAN JOURNAL OF SURGERY | Cohort study (98 patients/18 UC) Data covers the years 1982 to 1993 | Evaluation of IH prefascial/onlay polypropylene mesh repair post RYGBP vs total abdominal colectomy and IPAA for UC | Primary closure + prefascial/onlay mesh repair | Polypropylene | Complications occurred in 35% of the patients such as haematoma, seroma, minor wound infections. Major wound infections 5%. No enterocutaenous fistula or chronic wound drainage reported. Recurrence 4%. No reported difference between groups | Mean 20 + 2 months (range 6 to 104) | 13.5; III |
Aycock et al. (2007) JOURNAL OF WOUND, OSTOMY & CONTINENCE NURSING | Series (11 patients, 9 had IBD) From 2004 to 2006 | The use of Acellular dermal matrix in parastomal hernia repairs | Onlay repair (72%) and Inlay techniques | Acellular dermal matrix | Complications: 2 (18%) wound infections Recurrence: 2 (18%) clinical recurrence. 1 subclinical/CT proven recurrence | Mean 8.7 months (range 1 to 21 months) | 11; IV |
Taman et al. (2009) DISEASES OF COLON & RECTUM | Cohort study, 13 IBD patients with parastomal hernia From 2006 to 2007 | To study patients with parastomal hernia, repair of stoma site and abdominal wall with hADM | Neofascia creation using two separate layers of human acellular dermal matrix reconstructed with human acellular dermal matrix | human Acellular Dermal Matrix: hADM (LifeCell, Branchburg, NJ) | Seroma formation, incisional separation (2 patients each, 15.4 percent), and superficial wound infection (1 patient, 7.7 percent). There were two cases of asymptomatic hernia recurrence as determined by CT | M 290 (range 137–509) days | 14; II |
Maman et al. (2012) ANNALS OF PLASTIC SURGERY | Cohort study A total of 59 patients, 38 (64.4%) had IBD From 1999 to 2007 | To study the modified Rives-Stoppa repair for complex incisional hernias | Rives-Stoppa repair. Mesh is anchored in the retrorectus position/sublay via nonabsorbable sutures | ePTFE and poly-propylene | Complications: seroma (6.8%), wound/ mesh infection (6.8%) Recurrence: (1.7%) None of the patients developed bowel fistula | Mean 40.0 mo. (range, 6.7–117.6 mo.) | 12.75; III |
Wang et al. (2016) THE AMERICAN SURGEON | Cohort study (38 patients) all had IBD From 2007 to 2013 | The study of the ventral hernia repair with retrorectus mesh reinforcement in patients with IBD | Sublay mesh repair, retrorectus mesh rein-forcement with mid-line reapproximation of fascia with restoration of linea alba (LA). Rives-Stoppa retrorectus repair if hernia size did not preclude repair of LA without a component parting and adequate mesh overlap in confines of the rectus sheath | Altogether 22 (58%) biologic mesh and 16 (42%) synthetic mesh | Altogether 3 wound infections and 1 seroma/hematoma. Surgical site infection occurred in 7 (18.4%) patients. No reported mesh infection Recurrence: 3 (9.4%) No instances of postoperative intestinal complications or enterocutaneous fistulae | 3–4 weeks, 3 mo., 6 mo. 1 year and then annually M follow-up (FU) 32 mo. (3–83 mo.) + remaining 32 cases with M FU of 37 mo (range, 13–83 mo.) | 13.5; III |
Heimann et al. (2017) THE AMERICAN JOURNAL OF SURGERY | Cohort study (170 patients) all had IBD From 1976 to 2014 | To determine the outcome of incisional hernia (IH) repair in patients with IBD and the factors that correlate with recurrence of IH | Open repair (92.4%), laparoscopic (7.6%). Primary suture repair (38.2%) | Biologic mesh (7.6%), synthetic mesh (50.6%), biologic and synthetic mesh (3.5%), onlay mesh repair (59%) and sublay (41%) | Altogether 61 had onlay, 1 got mesh infection; 31 patients had inlay synthetic mesh repair. In 3 cases, late onset enterocutaneous fistulas were identified after IH repair with synthetic mesh inlay. Hernia recurrence in 46 cases; 38 of these patients underwent a second IH repair and 10 (26%) recurred again | Mean 56 months | 15: II |
Beyer-Berjot et al. (2020) WORLD JOURNAL OF SUGERY | Retrospective multicentre controlled study (234 with 114 Crohn’s disease patients) From 2000 to 2017 | To assess the risk of septic morbidity (SM) after ventral hernia mesh repair in patients with Crohn’s disease (CD) | All types of VH repair were used, provided that they included mesh positioning. All types of mesh were used (absorbable, perma-nent synthetic or biological) with all means of mesh fixation (threads or tackers). Mesh was placed as IPOM or sublay (i.e., retro-rectus) by laparosco pic or open approach | Permanent synthetic mesh in 95 patients with CD vs. 109 controls. Absorbable mesh in 6 CD patients vs. 7 controls and biological mesh in 11 CD patients vs. 4 controls | Altogether 12 patients (10.4%) had chronic mesh infection, including 8 intestinal fistulas involving the mesh (7%), leading to late reoperations in 9 cases (7.8%) and mesh withdrawal in 6 cases (5.3%). SM occurred in 21 CD patients (18.4%); 11 patients (9.6%) experienced short-term abdominal SM with either wound (7%) or intra-abdominal sepsis (2.6%), leading to two reoperations (1.7%) and one CT-guided drainage (0.9%). Recurrence: 16 (14%) in patients with CD | Median follow-up of 21.3 months (1–132) | 16.25; I |
Heise et al. (2021) BMC SURGERY | Retrospective analysis ( total of 223 patients, 34 had IBD) From 2005 to 2018 | To study the role of IBD as perioperative risk factor in open ventral hernia repair (OVHR) and the role of IBD on hernia recurrence | IH repair was performed as OVHR with mesh augmentation in sublay position | A PVDF-mesh (DynaMesh®, FEG-Textiltechnik) was placed in sublay position on peritoneum and posterior rectus sheath | OVHR in patients with IBD carried higher rate of intraoperative blood transfusions, major complications, and postoperative relaparotomies. IBD predicts per se major postoperative morbidity. Hernia recurred in 9 out of 34 patients: 15 suffered from UC and 19 from CD. UC was often associated with IH recurrence compared to CD | Median 36 months | 14.5; II |
Horesh et al. (2021) EUROPEAN JOURNAL OF GASTRO-ENTEROLOGY & HEPATO-LOGY | Retrospective analysis of a pro-spective database (5467 IBD cases, 26 got inguinal hernia repair) From 2008 to 2019 | To assess surgical outcome in patients with IBD with inguinal hernia repair and to assess risk factors | Prolene mesh was used to reconstruct the inguinal canal and close the hernia site defect | Prolene mesh | Three intraoperative complications were recorded (1 bladder injury and 2 orchiectomies). Postoperative complications occurred in eight patients most commonly wound related (three wound infections and one postoperative seroma). One patient required reoperation due to bowel obstruction. Hernia recurrence was seen in two patients during follow-up | Follow-up time mean 2.55 years | 14: II |
Perl-Mutter et al. (2021) HERNIA | Cohort retrospective study of 40 patients with CD From 2014 to 2018 | To describe the post-operative results and healthcare resource utilization after incisional hernia repair with synthetic mesh in patients with CD | Open incisional hernia repair with extra-peritoneal synthetic mesh | 38 had synthetic mesh placed in sub-lay position, 2 had onlay, 36, had medium weight polypropylene mesh; 39 got repair with 1 mesh to cover all defects,1 had a medium weight mesh to repair the para-stomal defect, a heavy weight mesh was used to repair the midline defect | A total of 16 patients had complications or recurrence. 6 were readmitted in 30 days, 4 had abdominal pain, nausea, and vomiting, 1 diarrhea and 1 SSI. 1 had revision of hernia repair 8 days postoperatively for small bowel obstruction using coated medium weight polypropylene mesh, and got 35 days after enterocutaneous fistula with mesh excision; 3 got SSI in 30 days, 1 superficial and 2 deep. 4 had SSO: 1 got a small area of fat necrosis, 1 got a short incisional skin separation, 1 had seroma, and 1 wound cellulitis. During follow-up of 42 mo., 8 patients had recurrence of hernia, at 18 mo. 2 of these 8 patients had repair | Follow-up Md 42 mo | 13.25; III |
Results of quality and evidence-grade assessments
Results of individual studies
Study | Patients with CD | Patients with UC | Patients with IBD | Controls | Risk factors for patients with IBD of post-operative complications | Statistics p < | Hazard ratio (HR) |
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Beyer-Berjot et al | 114 | 114 | 120 | • CD > UC for septic morbidity • Entero-prosthetic fistula • Mesh withdrawals • Biological mesh • Malnutrition • Concomitant procedure • Overall abdominal septic morbidity (SM) • Short-term abdominal SM • Long-term abdominal SM • Hernia recurrence in CD patients 14% | .001 .01 .011 .0001 .004 .004 .001 .025 .002 | ||
Heimann et al | 78 | 92 | 170 | • n of bowel resections prior to hernia repair predicted recurrence of IH • Biologic mesh • Recurrence 27% | .01 .01 | HR = 1.59 | |
Heise et al | 19 | 15 | 34 | 199 | • Patients with UC suffer more from hernia recurrence than those with CD • More than 1 bowel resection plus extraintestinal manifestations with hernia • Intraoperative blood transfusion • Major complications • Postoperative relapatomies • Intensive care due to post-operative complications • Intensive care morbidity predictor • Recurrence 26.5% | .02 .02 .001 .001 .006 .001 .001 | HR = 11.7 > HR = 1.0 HR = 11.68 HR = 13.31 HR = 3.5 HR = 3.67 |
Horesh et al | 14 | 12 | 26 | 76 | • Surgery duration risk factor for IBD patients • Patients with IBD more postoperative complications than controls | .0001 .03 |