Background
There is lack of consensus in managing traumatic abdominal wall hernia (TAWH) due to rarity and variability in clinical presentation, including need for trauma laparotomy for concurrent visceral injury. The influence of timing and mode of repair on recurrence is poorly characterised. This systematic review aimed to evaluate recurrence outcomes with repair technique (mesh versus direct suture repair) and timing of repair (acute versus elective) with and without trauma laparotomy.
Methods
A comprehensive search was conducted on Medline, Embase and Cochrane central databases. Keywords related to traumatic abdominal wall hernia, acute and elective treatment and timing of repair were used to identify relevant articles.
Results
A total 26 studies involving 432 patients were included. There were lower odds of recurrence with mesh compared to direct suture repair in patients with TAWH who did not require trauma laparotomy (OR 0.20, p=0.02), although no difference in acute versus elective repair in this cohort. There was no significant difference between mesh and direct suture repair for the management of TAWH in patients requiring trauma laparotomy.
Conclusion
This systematic review identified evidence to support lower odds of recurrence with mesh compared to direct suture repair for a patient with TAWH who did not require trauma laparotomy. There was insufficient evidence of superiority demonstrated for mesh compared to direct suture repair in trauma laparotomy settings, nor timing of repair in non-trauma laparotomy settings. The strength of the conclusions are limited by the risk of bias in included studies, and their heterogeneity.