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      Does negative pressure wound therapy applied to closed incisions following ventral hernia repair prevent wound complications and hernia recurrence? A systematic review and meta-analysis

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          Abstract

          Ventral hernia repair represents one of the most common procedures performed by plastic and reconstructive surgeons. Despite technical advances and increased understanding over the past 30 years, however, postoperative wound complications continue to account for significant morbidity and, in turn, decreased quality of life and increased health care costs. The aim of this analysis was to determine whether the application of negative pressure wound therapy to closed incisions decreases the rate of complications compared with conventional dressings.

          Abstract

          BACKGROUND

          Despite advances in surgical technique, ventral hernia repair (VHR) remains associated with significant postoperative wound complications.

          OBJECTIVE

          A systematic review and meta-analysis was performed to identify whether the application of negative pressure wound therapy to closed incisions (iNPWT) following VHR reduces the risk of postoperative wound complications and hernia recurrence.

          METHODS

          The PubMed/MEDLINE, EMBASE and SCOPUS databases were searched for studies published through October 2015. Publications that met the following criteria were included: adult patients undergoing VHR; comparison of iNPWT with conventional dressings; and documentation of wound complications and/or hernia recurrence. The methodological quality of included studies was independently assessed using the Methodological Index for Non-Randomized Studies guidelines. Outcomes assessed included surgical site infection (SSI), wound dehiscence, seroma, and hernia recurrence. Meta-analysis was performed to obtain pooled ORs.

          RESULTS

          Five retrospective cohort studies including 477 patients undergoing VHR were included in the final analysis. The use of iNPWT decreased SSI (OR 0.33 [95% CI 0.20 to 0.55]; P<0.0001), wound dehiscence (OR 0.21 [95% CI 0.08 to 0.55]; P=0.001) and ventral hernia recurrence (OR 0.24 [95% CI 0.08 to 0.75]; P=0.01). There was no statistically significant difference in the incidence of seroma formation (OR 0.59 [95% CI 0.27 to 1.27]; P=0.18).

          CONCLUSION

          For patients undergoing VHR, current evidence suggests a decreased incidence in wound complications using incisional NPWT compared with conventional dressings.

          Translated abstract

          HISTORIQUE

          Malgré les progrès des techniques chirurgicales, la réparation de la hernie ventrale (RHV) s’associe encore à des complications importantes de la plaie postopératoire.

          OBJECTIF

          Les chercheurs ont réalisé une analyse systématique et une méta-analyse pour déterminer si la thérapie par pression négative sur des incisions fermées (TPNiF) après la RHV réduit le risque de complications postopératoires des plaies et la récurrence des hernies.

          MÉTHODOLOGIE

          Les chercheurs ont exploré les bases de données PubMed/MEDLINE, EMBASE et SCOPUS pour trouver des études publiées jusqu’en octobre 2015. Ils ont retenu les publications qui respectaient les critères suivants : patients adultes ayant subi une RHV, comparaison de la TPNiF avec des pansements classiques et les rapports sur les complications des plaies ou la récurrence des hernies. Ils ont évalué de manière indépendante la qualité méthodologique des études retenues à l’aide des directives de l’indice méthodologique des études non aléatoires. Ils ont évalué les résultats suivants : l’infection au foyer de l’opération (IFO), la déhiscence de la plaie, le sérome et la récurrence des hernies. Ils ont effectué une méta-analyse pour obtenir les rapports de cote (RC) regroupés.

          RÉSULTATS

          Les chercheurs ont retenu cinq études de cohorte rétrospectives, y compris 477 patients qui avaient subi une RHV, dans l’analyse définitive. Le recours à la TPNiF réduisait l’IFO (RC 0,33 [95 % IC 0,20 à 0,55]; P<0,0001), la déhiscence de la plaie (RC 0,21 [95 % IC 0,08 à 0,55]; P=0,001) et la récurrence de la hernie ventrale (RC 0,24 [95 % IC 0,08 à 0,75]; P=0,01). Ils n’ont pas constaté de différence statistiquement significative dans l’incidence de formation de séromes (RC 0,59 [95 % IC 0,27 à 1,27]; P=0,18).

          CONCLUSION

          Pour les patients qui subissent une RHV, les données actuelles indiquent que l’incidence des complications des plaies est moins élevée si on utilise la TPNiF plutôt que les pansements classiques.

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          Author and article information

          Journal
          Plast Surg (Oakv)
          Plast Surg (Oakv)
          Plastic Surgery
          Pulsus Group Inc
          2292-5503
          2292-5511
          Summer 2016
          27 May 2016
          : 24
          : 2
          : 113-118
          Affiliations
          [1 ]Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
          [2 ]Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, China Medical University School of Medicine, Taichung City, Taiwan
          Author notes
          Correspondence: Dr Anand Kumar, Johns Hopkins Children’s Center, 1800 Orleans Street, Bloomberg 7314A, Baltimore, Maryland 21281, USA. Telephone 410-955-9475, fax 410-955-7060, e-mail akumar40@ 123456jhu.edu
          Article
          PMC4942233 PMC4942233 4942233 ps-24-2-113
          4942233
          27441196
          ©2016 Canadian Society of Plastic Surgeons. All rights reserved
          Categories
          Review

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