Long-term Outcome with the Prophylactic Use of Polypropylene Mesh in Morbidly Obese Patients Undergoing Biliopancreatic Diversion

The use of prosthetic material to prevent incisional hernia in clean-contaminated procedures as bariatric surgery remains controversial. We present our experience on 45 consecutive morbidly obese patients undergoing biliopancreatic diversion that was closed using a polypropylene mesh. Moreover, we reviewed the outcome of the 50 previous consecutive obese patients who underwent biliopancreatic diversion and conventional closure of the abdomen in order to compare the outcome between the two groups after a minimum follow-up of 2 years. Between January 2006 and February 2010, 95 morbidly obese patients underwent open biliopancreatic diversion at our department. During the first 2 years of our experience, there were 50 obese patients whose open biliopancreatic diversion was closed conventionally (without mesh). Starting on February 2008 and until February 2010, 45 patients received prophylactic midline reinforcement by the positioning of retrorectal muscle polypropylene mesh. The outcome at 3, 6, 12, and 24 months was analyzed comparing the two groups of patients. No mesh infection occurred. Minor local complications occurred similarly in both groups. The incidence of postoperative hernia was significantly higher in the group conventionally closed (30%) than in the mesh group (4.4%) at 2-year follow-up (p < 0.05). The prophylactic use of mesh in open bariatric surgery is safe and effective at 2-year follow-up.