SSO and mesh prophylactic for Incisional Hernia
Background: The use of mesh is the standard for the prevention of incisional hernia (IH). However, the effect of surgical site occurrence (SSO) has never been compared. The aim of this meta-analysis was to evaluate the prevalence of SSO and measure its negative effect through the calculation of the number needed to treat for net effect (NNT net). Methods: A meta-analysis was performed according to the PRISMA guidelines. The primary objective was to determine the prevalence of SSO and IH, and the secondary objective was to determine the NNT net as a metric to measure the combined benefits and harms. Only published clinical trials were included. The risk of bias was analyzed, and the random effects model was used to determine statistical significance. Results: 15 studies comparing 2,344 patients were included. The incidence of IH was significantly lower in the mesh group than in the control group, with an OR of 0.29 (95% CI 0.16-0.49 p= 0.0001). The incidence of SSO was significantly high in the mesh group than in the control group, with an OR of 1.21 (95% CI 0.85-1.72 p=0.0001). So, the way to compare the benefits and risks of each of the studies was done with the calculation of the Number Needed to Treat for net effect NNTnet, which is the average number of patients who are needed to be treated to see the benefit exceeding the harm by one event, and the result was 5, which is the average number of patients who are needed to be treated to see the benefit exceeding the harm by one event. Conclusion: The use of the mesh reduces the prevalence of IH and increases the prevalence of SSO, but NNT net determined that the use of mesh continues to be beneficial for the patient.