Mesh placement and the risk of recurrence and ileus in primary ventral hernia repair: A systematic review and network meta-analysis.

Abstract

<h4>Background</h4>Primary ventral hernia repair is a common surgical procedure. Although mesh use reduces the risk of recurrence, the optimal anatomic location remains unclear. This study aimed to evaluate recurrence rates based on mesh placement, with ileus as a secondary outcome.<h4>Methods</h4>This review included studies comparing mesh placements in adults undergoing elective primary ventral hernia repair with synthetic mesh, hernia defects ≤10 cm, and at least 6 months of follow-up. PubMed, Embase Ovid, and Cochrane CENTRAL were searched on February 17, 2025. The review was registered in PROSPERO (CRD 420251013190). The risk of bias was assessed using Cochrane's RoB-2 tool and the Newcastle-Ottawa Scale. Data were synthesized using network meta-analysis.<h4>Results</h4>A total of 21 studies involving 11,037 adult patients were included. Thirteen studies were eligible for the network meta-analysis, which demonstrated no significant differences in recurrence rates among preperitoneal, retromuscular, intraperitoneal onlay mesh, and onlay mesh placements. The certainty of the evidence was rated as low. Only 1 study reported ileus, with 3 cases among 318 patients.<h4>Conclusion</h4>No differences in recurrence rates were observed among the anatomic layers of mesh placements. The results suggest that the increasing use of retromuscular and preperitoneal mesh placements is not supported by strong comparative evidence. There was insufficient evidence to assess any association between ileus and the different mesh placements. However, most of the included studies had relatively short follow-up periods, which may limit the assessment of long-term outcomes and highlight the need for further research.