Prophylactic onlay mesh repair (POMR) versus primary suture repair (PSR) for prevention of incisional hernia (IH) after abdominal wall surgery: a systematic review and meta-analysis

Hassan, Maha Awaiz and Yunus, Rossita Mohamad and Khan, Shahjahan ORCID: and Memon, Muhammed Ashraf (2021) Prophylactic onlay mesh repair (POMR) versus primary suture repair (PSR) for prevention of incisional hernia (IH) after abdominal wall surgery: a systematic review and meta-analysis. World Journal of Surgery, 45. 3080 -3091. ISSN 0364-2313


With many different operative techniques in use to reduce the incidence of incisional hernias (IH) following a midline laparotomy, there is no consensus among the clinicians on the efficacy and safety of any particular repair technique. This meta-analysis compares the prophylactic onlay mesh repair (POMR) and primary suture repair (PSR) for the incidence of IH.

A meta-analysis and systematic review of MEDLINE, PubMed Central (via PubMed), Embase (via Ovid), SCOPUS, ScienceDirect, Google Scholar, SCI and Cochrane Library databases were undertaken. Seven randomized controlled trials assessing the outcomes of PSR and POMR were analyzed in accordance with the PRISMA statement. The risk of bias was assessed using the Rob2 tool.

According to the pooled analysis, POMR significantly reduced the incidence of IH compared to the PSR (OR 5.82 [95% CI 2.69, 12.58] P < 0.01) with a significantly higher seroma formation rate post-surgery (OR 0.35 [95% CI 0.18, 0.67] P < 0.01). Furthermore, the length of hospital stay (WMD −0.78 [95% CI −1.58, 0.02] P = 0.05) was significantly shorter for PSR compared to POMR group. Comparable effects were noted for reintervention, postoperative ileus, postoperative hematoma, postoperative mortality, long-term intervention and long-term deaths between the two groups.

POMR significantly reduces the risk of IH when compared to the PSR, with an increased risk of postoperative seroma formation and longer hospital stay. However, more RCTs with standardized protocols are needed for meaningful comparisons of the two interventions, along with longer duration of follow-up to assess the impact on the occurrence of IH.

Statistics for USQ ePrint 42826
Statistics for this ePrint Item
Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Published online: 19 July 2021. Permanent restricted access to ArticleFirst version, in accordance with the copyright policy of the publisher.
Faculty/School / Institute/Centre: Historic - Faculty of Health, Engineering and Sciences - School of Sciences (6 Sep 2019 - 31 Dec 2021)
Faculty/School / Institute/Centre: Current - Institute for Resilient Regions - Centre for Health Research (1 Apr 2020 -)
Date Deposited: 20 Jul 2021 23:56
Last Modified: 28 Oct 2021 23:43
Uncontrolled Keywords: prophylactic onlay mesh repair; primary suture repair; incisional hernia; prevention
Fields of Research (2008): 01 Mathematical Sciences > 0104 Statistics > 010401 Applied Statistics
11 Medical and Health Sciences > 1199 Other Medical and Health Sciences > 119999 Medical and Health Sciences not elsewhere classified
11 Medical and Health Sciences > 1117 Public Health and Health Services > 111706 Epidemiology
Fields of Research (2020): 42 HEALTH SCIENCES > 4202 Epidemiology > 420204 Epidemiological methods
49 MATHEMATICAL SCIENCES > 4905 Statistics > 490502 Biostatistics
49 MATHEMATICAL SCIENCES > 4905 Statistics > 490501 Applied statistics
42 HEALTH SCIENCES > 4206 Public health > 420699 Public health not elsewhere classified
Socio-Economic Objectives (2008): E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
E Expanding Knowledge > 97 Expanding Knowledge > 970101 Expanding Knowledge in the Mathematical Sciences
Identification Number or DOI:

Actions (login required)

View Item Archive Repository Staff Only