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World Journal of Surgery
Published in: World Journal of Surgery 8/2013

01-08-2013

Prophylactic Mesh Placement in High-Risk Patients Undergoing Elective Laparotomy: A Systematic Review

Authors: Subramanian Nachiappan, Sheraz Markar, Alan Karthikesaligam, Paul Ziprin, Omar Faiz

Published in: World Journal of Surgery | Issue 8/2013

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Abstract

Background

Incisional hernia is a significant complication in patients undergoing elective laparotomy. Its incidence is increased in patients with risk factors, such as obesity and chronic respiratory disease. The purpose of this pooled analysis was to evaluate the use of prophylactic mesh placement following laparotomy in high-risk patients.

Methods

A systematic literature search of MEDLINE, Embase, Web of Science, and Cochrane database was conducted. Outcome measures were incidence of postoperative incisional hernia, seroma, and wound infection rates.

Results

Five randomized, controlled trials (RCTs) and four comparative studies that met the inclusion criteria were identified. In total, 464 patients who underwent laparotomy closure with mesh placement and 755 patients who underwent conventional laparotomy closure were included. A reduced incidence of incisional hernia was observed when laparotomy was combined with prophylactic mesh placement in pooled analysis of RCTs (pooled odds ratio = 0.32; 95 % confidence interval = 0.12–0.83; P = 0.02) and comparative studies (pooled odds ratio = 0.11; 95 % confidence interval = 0.04–0.33; P < 0.001) respectively. No significant differences were observed in the incidence of seroma or wound infection following prophylactic mesh placement.

Conclusions

The results of this pooled analysis suggest a benefit to prophylactic mesh placement during laparotomy closure in high-risk patients with a significantly reduced incidence of incisional hernia without any significant differences in seroma formation and wound infection rates. Further studies must evaluate the incidence of mesh-specific complications, including foreign body sensation and chronic pain, before strong recommendations can be made.
Literature
1.
Koniaris LG, Hendrickson RJ, Drugas G, Abt P, Schoeniger LO (2001) Dynamic retention: a technique for closure of the complex abdomen in critically ill patients. Arch Surg 136(12):1359–1362 discussion 1363PubMedCrossRef
2.
Wissing J, Van Vroonhoven TJ, Schattenkerk ME, Veen HF, Ponsen RJ, Jeekel J (1987) Fascia closure after midline laparotomy: results of a randomized trial. Br J Surg 74(8):738–741PubMedCrossRef
3.
Abrahamson J (1997) Postoperative ventral abdominal hernia. In: Zinner MJ, Schwartz SI (eds) Maingot’s abdominal operation, 10th edn. Appleton and Lange, Stanford, pp 479–580
4.
5.
Kelman CI, Robert FDDR et al (2002) Wound healing. In: Schwartz SI, Tom GS, Spencer FC, Daly JM, Fischer JEGA (eds) Principles of surgery, 7th edn. McGraw-Hill, New York, pp 263–297
6.
Ellis H, Gajraj H, George CD (1983) Incisional hernias: when do they occur? Br J Surg 70(5):290–291PubMedCrossRef
7.
Bucknall TE, Cox PJ, Ellis H (1982) Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. BMJ 284(6320):931–933PubMedCrossRef
8.
9.
Mudge M, Hughes LE (1985) Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg 72(1):70–71PubMedCrossRef
10.
Conze J, Klinge U, Schumpelick V (2005) [Incisional hernia]. Der Chirurg 76(9):897–909 quiz 910CrossRef
11.
Colombo M, Maggioni A, Parma G, Scalambrino S, Milani R (1997) A randomized comparison of continuous versus interrupted mass closure of midline incisions in patients with gynecologic cancer. Obstet Gynecol 89(5 Pt 1):684–689PubMedCrossRef
12.
Burns EM, Currie A, Bottle A, Aylin P, Darzi a, Faiz O (2013) Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery. Br J Surg 100(1):152–159PubMedCrossRef
13.
Martín-Duce A, Noguerales F, Villeta R, Hernández P, Lozano O, Keller J, Granell J (2001) Modifications to Rives technique for midline incisional hernia repair. Hernia 5(2):70–72PubMedCrossRef
14.
Hunt SR (2012) Prevention of parastomal hernias. Sem Colon Rectal Surg 23(1):37–41CrossRef
15.
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Controlled Clin Trials 7(3):177–188PubMedCrossRef
16.
Bevis PM, Windhaber RA, Lear PA, Poskitt KR, Earnshaw JJ, Mitchell DC (2010) Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. Br J Surg 97(10):1497–1502PubMedCrossRef
17.
El-Khadrawy OH, Moussa G, Mansour O, Hashish MS (2009) Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients. Hernia 13(3):267–274PubMedCrossRef
18.
19.
Strzelczyk JM, Szymański D, Nowicki ME, Wilczyński W, Gaszynski T, Czupryniak L (2006) Randomized clinical trial of postoperative hernia prophylaxis in open bariatric surgery. Br J Surg 93(11):1347–1350PubMedCrossRef
20.
Gutiérrez de la Peña C, Medina Achirica C, Domínguez-Adame E, Medina Díez J (2003) Primary closure of laparotomies with high risk of incisional hernia using prosthetic material: analysis of usefulness. Hernia 7(3):134–136PubMedCrossRef
21.
Curro G, Centorrino T, Low V, Sarra G, Navarra G (2012) Long-term outcome with the prophylactic use of polypropylene mesh in morbidly obese patients undergoing biliopancreatic diversion. Obes Surg 22(2):279–282PubMedCrossRef
22.
Strzelczyk J, Czupryniak L, Loba J, Wasiak J (2002) The use of polypropylene mesh in midline incision closure following gastric by-pass surgery reduces the risk of postoperative hernia. Langenbeck’s Arch Surg 387(7–8):294–297CrossRef
23.
Escovar FJMJ et al (2009) Using non-absorbable mesh in patients at risk for evisceration in the prevention of colorectal surgery. The Association of Coloproctology of Great Britain and Ireland. Colorectal Dis 11(Suppl 2):26–62
24.
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. doi:10.​1007/​s00268-011-1131-6 PubMedCrossRef
25.
Sørensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jørgensen LN (2005) Smoking is a risk factor for incisional hernia. Arch Surg 140(2):119–123PubMedCrossRef
26.
Antoniou G, Georgiadis GS, Antoniou S, Granderath F, Giannoukas AD, Lazarides MK (2011) Abdominal aortic aneurysm and abdominal wall hernia as manifestations of a connective tissue disorder. J Vasc Surg 54(4):1175–1181PubMedCrossRef
27.
Yahchouchy-Chouillard E, Aura T, Picone O, Etienne J-C, Fingerhut A (2003) Incisional hernias. I. Related risk factors. Dig Surg 20(1):3–9PubMedCrossRef
28.
Markar SR, Karthikesalingam A, Alam F, Tang TY, Walsh SR, Sadat U (2010) Partially or completely absorbable versus nonabsorbable mesh repair for inguinal hernia: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 20(4):213–219PubMedCrossRef
29.
Szczerba SR, Dumanian GA (2003) Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg 237(3):437–441PubMed
30.
31.
Höer J, Fischer L, Schachtrupp A (2011) Laparotomy closure and incisional hernia prevention—what are the surgical requirements? Zentralblatt für Chirurgie 136(1):42–49PubMedCrossRef
32.
Beldi G, Insel University Hospital, Switzerland (2010) Mesh implantation for prophylaxis of incisional hernia. In: ClinicalTrials.gov [Internet]. National Library of Medicine (US), Bethesda
33.
Herwig P, Austrian Hernia Study Group, Austria (2012) Randomized controlled prospective multicenter study primary onlay-mesh after elective median laparotomy in patients with BMI ≥ 27. ClinicalTrials.gov [Internet]. National Library of Medicine, Bethesda
34.
Maurer CA, Kantonsspital Liestal, Switzerland (2009) Intraperitoneal mesh-implementation after laparotomy to reduce risk of incisional hernia: a prospective randomized controlled trial. In: ClinicalTrials.gov [Internet] National Library of Medicine, Bethesda
35.
Lange JF, Erasmus Medical Center, Rotterdam (2008) Primary mesh closure of abdominal midline wounds; a prospective randomized multicenter trial. ClinicalTrials.gov [Internet]. National Library of Medicine (US), Bethesda
36.
Universitätsklinikum Hamburg-Eppendorf. Germany (2011) Prophylactic mesh implantation after abdominal aortic aneurysm repair. a prospective, randomised, controlled study. ClinicalTrials.gov [Internet]. National Library of Medicine (US), Bethesda
37.
University Hospital (2008) Ghent, Belgium. Prevention of incisional hernia by mesh augmentation after midline laparotomy for aortic aneurysm treatment. ClinicalTrials.gov [Internet]. National Library of Medicine (US), Bethesda
Metadata
Title
Prophylactic Mesh Placement in High-Risk Patients Undergoing Elective Laparotomy: A Systematic Review
Authors
Subramanian Nachiappan
Sheraz Markar
Alan Karthikesaligam
Paul Ziprin
Omar Faiz
Publication date
01-08-2013
Publisher
Springer US
Published in
World Journal of Surgery / Issue 8/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-013-2046-1

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