Page 68 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 4
Results
Literature search
Out of 1,818 citations, a total of 23 RCTs with 10,130 patients were included in the meta-analyses (Figure 1). The level of agreement between the two assessors was moderate for screening abstracts and high for assessing eligibility of the full-texts. All studies were published in peer-reviewed journals from 1981 to 2015. One study was in French, and the remaining 22 studies were English. Study characteristics are listed in Table 1.
Risk of bias
Seven of the studies were considered high quality with the SIGN critical appraisal checklist, and the overall risk of bias was low. The most frequent source of bias was performance bias, as 12 of the studies did not report whether participants or personnel were blinded to the allocation. The funnel plots revealed no signs of publication bias.
Type of laparotomy
A total of 6 studies included only elective midline laparotomies(4, 12, 15-18). Nine of the studies included both emergency and elective midline laparotomies(2, 19-26), but none of them reported outcome data separately for the emergency or elective procedures. A total of 5 studies included emergency and elective procedures through all kinds of incisions(27-31), but again outcome data was not reported separately for emergency and elective procedures. Only two of the studies(30, 31) subgrouped the outcome data with regard to incision type and Sahlin et al. reported more incisional hernias and wound dehiscences in midline laparotomies, whereas Richards et al. found no signi cant di erences regarding type of incision.
Reporting of suture technique
The suture technique di ered widely between the studies, making it di cult to extract data on varying suture methods apart from continuous versus interrupted and small bites versus big bites technique. In 9 of the studies, the stitch size was not reported. Six studies(2, 4, 12, 15, 25, 32) reported that a 4:1 suture technique was used, but only half of them reported the speci c measurements(4, 12, 25).
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