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Systematic review and network meta-analysis of methods of mesh fixation during laparoscopic ventral hernia repair

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  1. Differential recurrence after laparoscopic incisional hernia repair: importance of a nationwide registry-based mesh surveillance

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  2. Response to: Meticulous surgical technique cannot be replaced by cholangiography

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  3. Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial

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  4. Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial

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  5. Associations between blood cultures after surgery for colorectal cancer and long-term oncological outcomes

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  1. More than one-third of Cochrane reviews had gift authors, whereas ghost authorship was rare

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Group authorships in Cochrane had low compliance with Cochrane recommendations

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  3. Half of Cochrane reviews were published more than 2 years after the protocol

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BACKGROUND: Ventral hernia repairs are common and have high recurrence rates. They are usually repaired laparoscopically with an intraperitoneal mesh, which can be fixed in various ways. The aim was to evaluate the recurrence rates for the different fixation techniques.

METHODS: This systematic review included studies with human adults with a ventral hernia repaired with an intraperitoneal onlay mesh. The outcome was recurrence at least 6 months after operation. Cohort studies with 50 or more participants and all RCTs were included. PubMed, Embase and the Cochrane Library were searched on 22 September 2016. RCTs were assessed with the Cochrane risk-of-bias assessment tool and cohort studies with the Newcastle-Ottawa scale. Studies comparing fixation techniques were included in a network meta-analysis, which allowed comparison of more than two fixation techniques.

RESULTS: Fifty-one studies with a total of 6553 participants were included. The overall crude recurrence rates with the various fixation techniques were: absorbable tacks, 17·5 per cent (2 treatment groups); absorbable tacks with sutures, 0·7 per cent (3); permanent tacks, 7·7 per cent (20); permanent tacks with sutures, 6·0 per cent (25); and sutures, 1·5 per cent (6). Six studies were included in a network meta-analysis, which favoured fixation with sutures. Although statistical significance was not achieved, there was a 93 per cent chance of sutures being better than one of the other methods.

CONCLUSION: Both crude recurrence rates and the network meta-analysis favoured fixation with sutures during laparoscopic ventral hernia repair.

Original languageEnglish
JournalThe British journal of surgery
Volume105
Issue number1
Pages (from-to)37-47
Number of pages11
ISSN0007-1323
DOIs
Publication statusPublished - Jan 2018

    Research areas

  • Hernia, Ventral, Herniorrhaphy, Humans, Laparoscopy, Models, Statistical, Recurrence, Surgical Mesh, Suture Techniques, Treatment Outcome, Journal Article, Meta-Analysis, Review

ID: 52407480