A Systematic Review and Meta-Analysis of Randomized Controlled Trials on Fascial Defect Closure Versus Bridged Repair in Laparoscopic Ventral Hernia Mesh Repair.

Abstract

This study compares the outcomes in patients undergoing ventral hernia repair using intraperitoneal underlay mesh (IPUM) without facial defect closure versus intraperitoneal underlay mesh following fascial defect closure (IPUM+). To search for randomized controlled trials comparing outcomes of patients with ventral hernias who were managed surgically with either IPUM or IPUM+, standard medical databases such as MEDLINE, Embase, PubMed, and Cochrane Library were used, covering studies published up to and including September 2025. The meta-analysis was performed with a random effect model analysis, and all data was analyzed using Review Manager Software 5.4. Five randomized controlled trials (n = 549) were included, involving adult patients who underwent laparoscopic ventral hernia repair with IPUM or IPUM+. The pooled analysis showed no significant difference in hernia recurrence (Risk Ratio [RR]: 0.82, 95% CI: [0.29, 2.27], p = 0.70), seroma formation (RR: 0.78, 95% CI: [0.32, 1.88], p = 0.58), operating times (Standard Mean Difference [SMD]: 0.26, 95% CI [-0.17, 0.69], p = 0.23) and pain scores (SMD: 0.26, 95% CI [-0.17, 0.69], p = 0.23) between the two approaches. IPUM and IPUM+ are both associated with similar postoperative morbidities for the treatment of ventral hernia repair.