Do traumatic abdominal wall hernia repairs yield consistent outcomes? a systematic review and pooled analysis of proportions

Traumatic abdominal wall hernias (TAWH) represent a complex surgical challenge with heterogeneous outcomes, and existing literature largely consists of isolated case reports, small series or retrospective cohorts. This study addresses the significant gap by systematically reviewing and aggregating outcome data through a pooled analysis of proportions, offering a more comprehensive perspective on the clinical outcomes associated with TAWH repairs.

PubMed, Web of Science, Cochrane Central, and EMBASE were systematically searched for studies including patients with TAWH. The primary outcomes were mortality, recurrence, and postoperative complication rates. Subgroup analyses were performed to compare recurrence rates after mesh versus primary repair, immediate versus non-immediate, and late versus elective repair. A leave-one-out sensitivity analysis was conducted to assess the robustness of the pooled estimates.

A total of 726 studies were screened, of which 22 met the inclusion criteria, comprising 786 patients. The pooled mean age was 38.2 years (SD 17.2), mean BMI 30.2 (SD 7.5), and ISS 23.4 (SD 6). The most common mechanism of trauma was motor vehicle collision (65.5%). Flank hernias were most common(32.9%) followed by lumbar (28.1%) hernias. According to the Dennis et al. (2009) classification, grades IV (43.2%) and V (42.6%) were the most common. Intra-abdominal injuries were reported in 71% of patients, with hollow viscus injury the most frequent (39.2%). Overall, 45.6% of patients did not undergo herniorrhaphy. The pooled mortality rate was 8% (95% CI, 5–12%), most often attributable to associated injuries rather than the hernia itself. The pooled recurrence rate was 14% (95% CI, 10–19%), and postoperative complications 17% (95% CI, 12–25%). The sensitivity analysis confirmed that the pooled estimates were robust, as the exclusion of any single study did not significantly alter the heterogeneity or overall findings. In subgroup analyses, nine studies compared immediate versus non-immediate repair with respect to recurrence (OR 1.58; 95% CI, 0.65–3.88; I² = 0%; p = 0.32), and four studies compared late versus elective repair (OR 2.69; 95% CI, 0.27–27.23; I² = 0%; p = 0.40). Thirteen studies compared mesh with primary repair, showing a significantly lower recurrence rate with mesh (OR 0.27; 95% CI, 0.08–0.93; I² = 0%; p = 0.036), although the 95% prediction interval was wide (0.02–3.51).

TAWH primarily affect severely injured patients after blunt trauma. Management should first focus on associated intra-abdominal injuries. While small ventral hernias may occasionally be repaired during the index laparotomy, evidence is limited, and our analysis did not confirm an optimal timeframe for repair. Lumbar and flank hernias, given their complexity, are more often managed in a delayed fashion. Mesh use was associated with lower recurrence, although heterogeneity across studies limits definitive recommendations.

"Level of Evidence: Level III, Systematic Review Study.”

A review protocol for this systematic review was registered at PROSPERO CRD420251089757 on August 6, 2025