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26-03-2023 | Laparotomy | Original Article

Does onlay mesh placement in emergency laparotomy prevent incisional hernia? A prospective randomized double-blind study

Authors: M. E. Ulutas, A. Sahin, G. Simsek, N. Sekmenli, A. Kilinc, K. Arslan, M. A. Eryilmaz, A. Kartal

Published in: Hernia | Issue 4/2023

Abstract

Purpose

The objective of this study is to assess the effectiveness and safety of onlay mesh closure of emergency midline laparotomy to prevent incisional hernia.

Methods

This is a prospective randomized double-blind study and was carried out in the General Surgery Clinic, Konya City Hospital, from August 1, 2020 to August, 1, 2021. The study included 108 patients who were randomly grouped in 2 groups: patients with conventional abdominal closure and closure using additional onlay mesh (1:1). The follow-up period was for a year. The primary outcome was the incidence of incisional hernia and secondary outcomes were clinical data like complications, hospital length of stay, re-operations.

Results

It was observed that incisional hernia was present in 14 patients (27.4%) in conventional abdominal closure group and was in 2 patients using mesh (4%), (p = 0.001). Clavien–Dindo 3B complications were in rise in conventional closure group (p = 0.02). Of all complications, burst abdomen was significantly more common in conventional closure group (p = 0.04). The rate of surgically treated complications were higher in conventional closure group (p = 0.02). Clavien–Dindo 3A complications were more common in patients with contaminated wound in mesh group (p = 0.02).

Conclusion

The use of mesh while closing the abdomen in emergency midline laparotomy reduces the risk of incisional hernia. Thus, to lower the risks of incisional hernia and its complications, prophylactic mesh can be used in high-risk patients.

Bhangu A, Fitzgerald JE, Singh P, Battersby N, Marriott P, Pinkney T (2013) Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy. Hernia 17(4):445–455. https://doi.org/10.1007/s10029-013-1119-2CrossRefPubMed

Llaguna OH, Avgerinos DV, Nagda P, Elfant D, Leitman IM, Goodman E (2011) Does prophylactic biologic mesh placement protect against the development of incisional hernia in high-risk patients? World J Surg 35(7):1651–1655. https://doi.org/10.1007/s00268-011-1131-6CrossRefPubMed

San Miguel C, Melero D, Jiménez E, López P, Robin A, Blázquez LA, García-Ureña MÁ (2018) Long-term outcomes after prophylactic use of onlay mesh in midline laparotomy. Hernia 22(6):1113–1122. https://doi.org/10.1007/s10029-018-1833-xCrossRefPubMed

García-Ureña MÁ, López-Monclús J, Hernando LAB, Montes DM, de Lersundi ARV, Pavón CC, Quindós PL. Randomized controlled trial of the use of a large-pore polypropylene mesh to prevent incisional hernia in colorectal surgery. Annals of Surgery. 2015; 261(5):876-881. https://doi.org/10.1097/SLA.0000000000001116CrossRefPubMed

Kurmann A, Barnetta C, Candinas D, Beldi G (2013) Implantation of prophylactic nonabsorbable intraperitoneal mesh in patients with peritonitis is safe and feasible. World J Surg 37(7):1656–1660. https://doi.org/10.1007/s00268-013-2019-4CrossRefPubMed

Jairam AP, López-Cano M, García-Alamino JM, Pereira JA, Timmermans L, Jeekel J, Muysoms F (2020) Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis. BJS Open 4(3):357–368. https://doi.org/10.1002/bjs5.50261CrossRefPubMedPubMedCentral

Bevis PM, Windhaber RAJ, Lear PA, Poskitt KR, Earnshaw JJ, Mitchell DC (2010) Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. J Br Surg 97(10):1497–1502. https://doi.org/10.1002/bjs.7137CrossRef

Fischer JP, Basta MN, Wink JD, Krishnan NM, Kovach SJ (2015) Cost-utility analysis of the use of prophylactic mesh augmentation compared with primary fascial suture repair in patients at high risk for incisional hernia. Surgery 158(3):700–711. https://doi.org/10.1016/j.surg.2015.02.030CrossRefPubMed

Payne R, Aldwinckle J, Ward S (2017) Meta-analysis of randomised trials comparing the use of prophylactic mesh to standard midline closure in the reduction of incisional herniae. Hernia 21(6):843–853. https://doi.org/10.1007/s10029-017-1653-4CrossRefPubMed

10.

Sugrue M, Johnston A, Zeeshan S, Loughlin P, Bucholc M, Watson A (2019) The role of prophylactic mesh placement to prevent incisional hernia in laparotomy. Is it time to change practice? Anaesthesiol Intensiv Ther. 51(4):323–329. https://doi.org/10.5114/ait.2019.87475CrossRef

11.

Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother 1(2):100–107. https://doi.org/10.4103/0976-500X.72352CrossRefPubMedPubMedCentral

12.

Fischer JP, Basta MN, Mirzabeigi MN, Bauder AR, Fox JP, Drebin JA, Kovach SJ (2016) A risk model and cost analysis of incisional hernia after elective, abdominal surgery based upon 12,373 cases: the case for targeted prophylactic intervention. Ann Surg 263(5):1010. https://doi.org/10.1097/SLA.0000000000001394CrossRefPubMed

13.

Li J (2021) Comment on: prophylactic sublay non-absorbable mesh positioning following midline laparotomy in a clean-contaminated field: randomized clinical trial (PROMETHEUS). Br J Surg 108(10):e351–e351. https://doi.org/10.1093/bjs/znab238CrossRefPubMed

14.

Tansawet A, Numthavaj P, Sumritpradit P, Techapongsatorn S, McKay G, Attia J, Thakkinstian A (2021) Midline incisional hernia prophylaxis using synthetic mesh in an emergency or urgent gastrointestinal tract surgery: a protocol for multicentre randomised clinical trial. BMJ Open 11(9):e045541. https://doi.org/10.1136/bmjopen-2020-045541CrossRefPubMedPubMedCentral

15.

Rhemtulla IA, Mauch JT, Broach RB, Messa CA, Fischer JP (2018) Prophylactic mesh augmentation: patient selection, techniques, and early outcomes. Am J Surg 216(3):475–480. https://doi.org/10.1016/j.amjsurg.2018.04.008CrossRefPubMed

16.

Feng YS, Kohlmann T, Janssen MF, Buchholz I (2021) Psychometric properties of the EQ-5D-5L: a systematic review of the literature. Qual Life Res 30(3):647–673. https://doi.org/10.1007/s11136-020-02688-yCrossRefPubMed

17.

Lima HV, Rasslan R, Novo FC, Lima TM, Damous SH, Bernini CO, Utiyama EM (2020) Prevention of fascial dehiscence with onlay prophylactic mesh in emergency laparotomy: a randomized clinical trial. J Am Coll Surg 230(1):76–87. https://doi.org/10.1016/j.jamcollsurg.2019.09.010CrossRefPubMed

18.

Burns FA, Heywood EG, Challand CP, Lee MJ (2020) Is there a role for prophylactic mesh in abdominal wall closure after emergency laparotomy? A systematic review and meta-analysis. Hernia 24(3):441–447. https://doi.org/10.1007/s10029-019-02060-1CrossRefPubMed

19.

Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, Berrevoet F (2015) European hernia society guidelines on the closure of abdominal wall incisions. Hernia 19(1):1–24. https://doi.org/10.1007/s10029-014-1342-5CrossRefPubMed

20.

Argudo N, Pereira JA, Sancho JJ, Membrilla E, Pons MJ, Grande L (2014) Prophylactic synthetic mesh can be safely used to close emergency laparotomies, even in peritonitis. Surgery 156(5):1238–1244. https://doi.org/10.1016/j.surg.2014.04.035CrossRefPubMed

21.

Afzal S, Bashir MM (2008) Determinants of wound dehiscence in abdominal surgery in public sector hospital. Ann King Edward Med Univ. 14(3):119–119. https://doi.org/10.21649/akemu.v14i3.46CrossRef

22.

Brandsma HT, Hansson BM, Aufenacker TJ, van Geldere D, Lammeren F, Mahabier C, Rosman C (2017) Prophylactic mesh placement during formation of an end-colostomy reduces the rate of parastomal hernia. Ann Surg 265(4):663–669. https://doi.org/10.1097/SLA.0000000000001903CrossRefPubMed

23.

Pereira-Rodríguez JA, Amador-Gil S, Bravo-Salva A, Montcusí-Ventura B, Sancho-Insenser J, Pera-Román M, López-Cano M (2022) Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool. Hernia 26(2):457–466. https://doi.org/10.1007/s10029-021-02527-0CrossRefPubMed

24.

El-Khadrawy OH, Moussa G, Mansour O, Hashish MS (2009) Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients. Hernia 13(3):267–274. https://doi.org/10.1007/s10029-009-0484-3CrossRefPubMed

25.

Pizza F, D’Antonio D, Ronchi A, Lucido FS, Brusciano L, Marvaso A, Gambardella C (2021) Prophylactic sublay non-absorbable mesh positioning following midline laparotomy in a clean-contaminated field: randomized clinical trial (PROMETHEUS). Br J Surg 108(6):638–643. https://doi.org/10.1093/bjs/znab068CrossRefPubMed

26.

Jänes A, Cengiz Y, Israelsson LA (2010) Experiences with a prophylactic mesh in 93 consecutive ostomies. World J Surg 34(7):1637–1640. https://doi.org/10.1007/s00268-010-0492-6CrossRefPubMed

27.

Hassan MA, Yunus RM, Khan S, Memon MA (2021) Prophylactic onlay mesh repair (POMR) versus primary suture repair (PSR) for prevention of incisional hernia (IH) after abdominal wall surgery: a systematic review and meta-analysis. World J Surg 45(10):3080–3091. https://doi.org/10.1007/s00268-021-06238-6CrossRefPubMed

28.

Kohler A, Lavanchy JL, Lenoir U, Kurmann A, Candinas D, Beldi G (2019) Effectiveness of prophylactic intraperitoneal mesh implantation for prevention of incisional hernia in patients undergoing open abdominal surgery: a randomized clinical trial. JAMA Surg 154(2):109–115. https://doi.org/10.1001/jamasurg.2018.4221CrossRefPubMed

Title: Does onlay mesh placement in emergency laparotomy prevent incisional hernia? A prospective randomized double-blind study
Authors: M. E. Ulutas
A. Sahin
G. Simsek
N. Sekmenli
A. Kilinc
K. Arslan
M. A. Eryilmaz
A. Kartal
Publication date: 26-03-2023
Publisher: Springer Paris
Keywords: Laparotomy
Laparotomy
Incisional Hernia
Published in: Hernia / Issue 4/2023
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-023-02770-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does onlay mesh placement in emergency laparotomy prevent incisional hernia? A prospective randomized double-blind study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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