A Summative Analysis and Systematic Review of Randomized Controlled Trials on Ventral Hernia Management
Ashlynn N. Mills, J. Scott Zimmerle, Grace DesRochers, Angelica Calderon Rodriguez, Brendan M. Rosamond, Duyen Quach, Nicole B. Lyons, Julie L. Holihan, Karla Bernardi, Michele Loor, Michael Rosen, Benjamin Poulose, Mazen Al-Mansour, Ajita Prabhu, Benjamin Miller, Filip Muysoms, Kamal M.F. Itani, Richard Lu, Mary Hawn, Scott Roth, Zuhair Ali, Mike K. LiangObjective:
This study systematically reviews the latest randomized controlled trials (RCTs) on ventral hernia repair (VHR) to provide an updated approach to ventral hernia (VH) management.
Summary Background Data:
VHR is a common surgical procedure with significant variation in management strategies. While guidelines exist, the evolution of surgical techniques and emerging evidence necessitate periodic updates to ensure best practices.
Methods:
A comprehensive search was conducted following PRISMA guidelines across EMBASE, PubMed, Cochrane, and ClinicalTrials.gov to identify RCTs published between May 1, 2015, and June 1, 2025. Eligible studies addressed VH and obesity, minimally invasive surgery, high-level decisions of mesh selection (use of mesh and mesh category), drain placement, and the use of abdominal binders. The primary outcome was hernia recurrence; secondary outcomes were surgical site infection, wound complications, and reoperation where reported. The strength of recommendation was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria.
Results:
A total of 78 RCTs were identified, and 21 studies met the inclusion criteria. The role of preoperative weight loss for patients seeking VHR is not clearly established by existing literature. The superiority of robotic surgery over laparoscopic surgery is also unclear. Findings show the benefit of synthetic mesh reinforcement in clean VHR. Limited evidence supports subcutaneous drain placement and postoperative abdominal binders for lowering overall complications and pain.
Conclusions:
The landscape of VHR highlights the need for ongoing reassessment of best practices. Further high-quality, multicenter RCTs are needed to optimize long-term surgical outcomes.
Registration:
Protocol available via PROSPERO (CRD42015020261; subprotocol CRD42020191138).