Evaluation of Mesh Closure of Laparotomy and Extraction Incisions in Open and Laparoscopic Colorectal Surgery: A Systematic Review and Meta-Analysis

Background and objectives: In colorectal surgery, postoperative evisceration and incisional her-nia (IH) were noted after open procedures and at extraction incision (EI) sites used in laparoscopic resections. This systematic review investigates the efficacy and safety of prophylactic mesh clo-sure of midline laparotomy or EI closure in colorectal oncological and non-oncological resections. Methods: Literature databases, including PubMed, Cochrane, Science Direct and Google Scholar, were searched for studies comparing the use of prophylactic mesh to conventional suture closure in colorectal operations, either in laparotomy closure in open surgery or EI closure in laparoscopic procedures, regardless of the indication; oncological and non-oncological. Primary endpoints were identified as incisional hernia (IH) and postoperative evisceration. Other outcomes included surgical site infection (SSI), seroma formation and length of hospital stay (LOS). Results: Six studies fulfilled the inclusion criteria and studied 1,398 patients, with 411 patients having prophylactic mesh insertion at the time of midline laparotomy or EI closure and 987 underwent conventional suture closure. The occurrence of IH was significantly reduced using mesh closure compared to suture closure (OR 0.23, P=0.00001), while there was no statistically significant dif-ference in evisceration rate (OR 0.51, P=0.25). Additionally, no notable difference was identified between both groups in terms of SSI (OR 1.20, P=0.54), postoperative seroma (OR 1.80, P=0.13), and LOS (MD -0.54, P=0.63). Conclusions: The use of prophylactic mesh on closing laparotomy incisions or EI for open and laparoscopic colorectal resections reduces the risk of developing IH. There were no significant safety concerns; however, further randomized trials may provide more robust results.