Prophylactic Intraperitoneal Onlay Mesh Reinforcement Reduces the Risk of Incisional Hernia, Two-Year Results of a Randomized Clinical Trial

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2017 Nov 22

PMID 29159603

Citations 19

Authors

Philippe Brosi

Philippe M Glauser

Benjamin Speich

Samuel A Kaser

Christoph A Maurer

Affiliations

Soon will be listed here.

Abstract

Background: Incisional hernias still are a major concern after laparotomy and are causing substantial morbidity. This study examines the feasibility, safety and incisional hernia rate of the use of a prophylactic intraperitoneal onlay mesh stripe (IPOM) to prevent incisional hernia following midline laparotomy.

Methods: This prospective, randomized controlled trial randomly allocated patients undergoing median laparotomy either to mass closure of the abdominal wall with a PDS-loop running suture reinforced by an intraperitoneal composite mesh stripe (Group A) or to the same procedure without the additional mesh stripe (Group B). Primary endpoint was the incidence of incisional hernias at 2 years following midline laparotomy. Secondary endpoints are were the feasibility, the safety of the mesh stripe implantation including postoperative pain, and the incidence of incisional hernias at 5 years.

Results: A total of 267 patients were included in this study. Follow-up data 2 years after surgery was available from 210 patients (Group A = 107; Group B = 103). An incisional hernia was diagnosed in 18/107 (17%) patients in Group A and in 40/103 (39%) patients in Group B (p < 0.001). A surgical operation due to an incisional hernia was conducted for 12/107 (11%) patients in Group A and for 24/103 (23%) patients in Group B (p = 0.039). In both groups, minor and major complications as well as postoperative pain are reported with no statistically significant difference between the groups, even in contaminated situations.

Conclusions: This first randomized clinical trial indicates that the placement of a non-absorbable IPOM-stripe with prophylactic intention may significantly reduce the risk for a midline incisional hernia.

Trial Registration: Ref. NCT01003067 (clinicaltrials.gov).

Citing Articles

Prophylactic mesh versus primary closure in emergency and elective surgeries: a systematic review and meta-analysis of randomized clinical trials.

Valerio-Alves A, Saggin C, de Aguiar Portela J, Viana P, Guerra G, de Paiva Reis C Hernia. 2024; 29(1):14.

PMID: 39549074 DOI: 10.1007/s10029-024-03202-w.

Short-term outcomes of a multicentre prospective study using a "visible" polyvinylidene fluoride onlay mesh for the prevention of midline incisional hernia.

Rodicio Miravalles J, Mendez C, Lopez-Monclus J, Moreno Gijon M, Lopez Quindos P, Amoza Pais S Langenbecks Arch Surg. 2024; 409(1):136.

PMID: 38652308 DOI: 10.1007/s00423-024-03307-x.

ONLAY VERSUS RIVES-STOPPA TECHNIQUES IN THE TREATMENT OF INCISIONAL HERNIAS.

Pereira-Rodrigues A, Maceio-Da-Graca J, Ferreira E, Alves-Almeida C Arq Bras Cir Dig. 2023; 36:e1766.

PMID: 37851752 PMC: 10578152. DOI: 10.1590/0102-672020230048e1766.

Optimal computed tomography-based biomarkers for prediction of incisional hernia formation.

Talwar A, Desai A, McAuliffe P, Broach R, Hsu J, Liu T Hernia. 2023; 28(1):17-24.

PMID: 37676569 PMC: 11235401. DOI: 10.1007/s10029-023-02835-7.

Prophylactic mesh augmentation after laparotomy for elective and emergency surgery: meta-analysis.

Frassini S, Calabretto F, Granieri S, Fugazzola P, Massaro M, Sargenti B BJS Open. 2023; 7(4).

PMID: 37504969 PMC: 10375944. DOI: 10.1093/bjsopen/zrad060.

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