The effect of prophylactic mesh implantation on the development of incisional hernias in patients with elevated BMI: a systematic review and meta-analysis.

BACKGROUND: Incisional hernia is a common complication after midline laparotomy. In certain risk profiles incidences can reach up to 70%. Large RCTs showed a positive effect of prophylactic mesh reinforcement (PMR) in high-risk populations. OBJECTIVES: The aim was to evaluate the effect of prophylactic mesh reinforcement on incisional hernia reduction in obese patients after midline laparotomies. METHODS: Following the PRISMA guidelines, a systematic literature search in Medline, Web of Science and CENTRAL was conducted. RCTs investigating PMR in patients with a BMI ≥ 27 reporting incisional hernia as primary outcome were included. Study quality was assessed using the Cochrane risk-of-bias tool and certainty of evidence was rated according to the GRADE Working Group grading of evidence. A random-effects model was used for the meta-analysis. Secondary outcomes included postoperative complications. RESULTS: Out of 2298 articles found by a systematic literature search, five RCTs with 1136 patients were included. There was no significant difference in the incidence of incisional hernia when comparing PMR with primary suture (odds ratio (OR) 0.59, 95% CI 0.34-1.01, p = 0.06, GRADE: low). Meta-analyses of seroma formation (OR 1.62, 95% CI 0.72-3.65; p = 0.24, GRADE: low) and surgical site infections (OR 1.52, 95% CI 0.72-3.22, p = 0.28, GRADE: moderate) showed no significant differences as well as subgroup analyses for BMI ≥ 40 and length of stay. CONCLUSIONS: We did not observe a significant reduction of the incidence of incisional hernia with prophylactic mesh reinforcement used in patients with elevated BMI. These results stand in contrast to the current recommendation for hernia prevention in obese patients.

The effect of exercise on reelin level in the hippocampus of diabetic rats.

AIM: Diabetes is one of the most common diseases which can attenuate brain function by destroying hippocampus neurons, while reelin is a largely secreted extracellular matrix glycoprotein in the hippocampus causing synaptic plasticity, promoting postsynaptic structures and maturing neurons. The aim of this study was to assess the effect of exercise, as an external factor for neurogenesis in the brain, on reelin levels and memory improvement in diabetic rats. METHOD: Thirty rats were randomly allocated into three groups; healthy sedentary, diabetic sedentary and diabetic exercise-trained. The experimental group was treadmill-exercised at speed 22 m/min for 1 hour, 5 days per week. Finally, spatial memory of rats was tested and reelin levels were measured. RESULTS: The results showed that short-term exercise improved spatial memory in diabetic rats but had no effect on reelin levels in the hippocampus of diabetic rats. CONCLUSION: Diabetes reduced the spatial memory without altering the reelin levels while exercise improved spatial memory without altering the reelin levels (Fig. 4, Ref. 33).