O26 INFECTIOUS COMPLICATION IN RELATION TO THE PROPHYLACTIC MESH POSITION: THE PRIMA TRIAL REVISITED

Abstract Aim Prophylactic mesh reinforcement has proven to reduce the incidence of incisional hernia (IH). Fear of infectious complications may withhold the widespread implementation of prophylactic mesh reinforcement, particularly in the onlay position. Material and Methods Patients scheduled for elective midline surgery were randomly assigned to a suture closure group, onlay mesh group, or sublay mesh group. The incidence, treatment, and outcomes of patients with infectious complications were assessed through examining the adverse event forms. Data were collected prospectively for 2 years after the index procedure. Results Overall, infectious complications occurred in 14/107 (13.3%) patients in the suture group and in 52/373 (13.9%) patients with prophylactic mesh reinforcement (p = 0.821). Infectious complications occurred in 17.6% of the onlay group and 10.3% of the sublay group (p = 0.042). Excluding anastomotic leakage as a cause, these incidences were 16% (onlay) and 9.7% (sublay), p = 0.073. The mesh could remain in-situ in 40/52 (77%) patients with an infectious complication. The 2-year IH incidence after onlay mesh reinforcement was 10 in 33 (30.3%) with infectious complications and 15 in 140 (9.7%) without infectious complications (p = 0.003). This difference was not statistically significant for the sublay group. Conclusions Prophylactic mesh placement was not associated with increased incidence, severity, or need for invasive treatment of infectious complications compared with suture closure. Patients with onlay mesh reinforcement and an infectious complication had a significantly higher risk of developing an incisional hernia, compared with those in the sublay group.

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Prevention of incisional hernia at the site of stoma closure with different reinforcing mesh types: a systematic review and meta-analysis

Hernia ◽

10.1007/s10029-021-02393-w ◽

2021 ◽

Author(s):

Roberto Peltrini ◽

Nicola Imperatore ◽

Gaia Altieri ◽

Simone Castiglioni ◽

Maria Michela Di Nuzzo ◽

...

Keyword(s):

Incisional Hernia ◽

Operative Time ◽

Meta Analysis ◽

Short Term ◽

Mesh Group ◽

Closure Technique ◽

Mesh Placement ◽

Mesh Reinforcement ◽

Significant Difference ◽

Significant Superiority

Abstract Purpose To evaluate safety and efficacy of a mesh reinforcement following stoma reversal to prevent stoma site incisional hernia (SSIH) and differences across the prostheses used. Methods A systematic search of PubMed/MEDLINE, EMBASE, SCOPUS and Cochrane databases was conducted to identify comparative studies until September 2020. A meta-analysis of postoperative outcomes and a network meta-analysis for a multiple comparison of the prostheses with each other were performed. Results Seven studies were included in the analysis (78.4% ileostomy and 21.6% colostomy) with a total of 1716 patients with (n = 684) or without (n = 1032) mesh. Mesh placement was associated with lower risk of SSIH (7.8%vs18.1%, OR0.266,95% CI 0.123–0.577, p < 0.001) than no mesh procedures but also with a longer operative time (SMD 0.941, 95% CI 0.462–1.421, p < 0.001). There was no statistically significant difference in terms of Surgical Site infection (11.5% vs 11.1%, OR 1.074, 95% CI 0.78–1.48, p = 0.66), seroma formation (4.4% vs 7.1%, OR 1.052, 95% CI 0.64–1.73, p = 0.84), anastomotic leakage (3.7% vs 2.7%, OR 1.598, 95% CI 0.846–3.019, p = 0.149) and length of stay (SMD − 0.579,95% CI − 1.261 to 0.102, p = 0.096) between mesh and no mesh groups. Use of prosthesis was associated with a significant lower need for a reoperation than no mesh group (8.1% vs 12.1%, OR 0.332, 95% CI 0.119–0.930, p = 0.036). Incidence of seroma is lower with biologic than polypropylene meshes but they showed a trend towards poor results compared with polypropylene or biosynthetic meshes. Conclusion Despite longer operative time, mesh prophylactic reinforcement at the site of stoma seems a safe and effective procedure with lower incidence of SSIH, need for reoperation and comparable short-term outcomes than standard closure technique. A significant superiority of a specific mesh type was not identified.

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Triple-Step Laparoscopic Incisional Hernia Repair: Midline Suture Closure Supported by Dorsal Component Separation and Intraperitoneal Onlay Mesh Reinforcement

World Journal of Surgery ◽

10.1007/s00268-014-2747-0 ◽

2014 ◽

Vol 38 (12) ◽

pp. 3276-3279 ◽

Cited By ~ 5

Author(s):

Christoph W. Strey

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Incisional Hernia Repair ◽

Component Separation ◽

Intraperitoneal Onlay Mesh ◽

Laparoscopic Incisional Hernia Repair ◽

Mesh Reinforcement ◽

Onlay Mesh ◽

Suture Closure

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Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement

Hernia ◽

10.1007/s10029-019-02042-3 ◽

2019 ◽

Vol 24 (1) ◽

pp. 93-98 ◽

Cited By ~ 1

Author(s):

A. G. Barranquero ◽

E. Tobaruela ◽

M. Bajawi ◽

P. Muñoz ◽

J. Die Trill ◽

...

Keyword(s):

Risk Factors ◽

Incisional Hernia ◽

Loop Ileostomy ◽

Ileostomy Closure ◽

Prophylactic Mesh ◽

Mesh Placement

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The role of prophylactic mesh placement to prevent incisional hernia in laparotomy. Is it time to change practice?

Anestezjologia Intensywna Terapia ◽

10.5114/ait.2019.87475 ◽

2019 ◽

Vol 51 (4) ◽

pp. 323-329

Author(s):

Michael Sugrue ◽

Alison Johnston ◽

Saqib Zeeshan ◽

Paula Loughlin ◽

Magda Bucholc ◽

...

Keyword(s):

Incisional Hernia ◽

Prophylactic Mesh ◽

Mesh Placement

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

World Journal of Surgery ◽

10.1007/s00268-017-4363-2 ◽

2017 ◽

Vol 42 (6) ◽

pp. 1687-1694 ◽

Cited By ~ 11

Author(s):

Philippe Brosi ◽

Philippe M. Glauser ◽

Benjamin Speich ◽

Samuel A. Käser ◽

Christoph A. Maurer

Keyword(s):

Clinical Trial ◽

Incisional Hernia ◽

Randomized Clinical Trial ◽

Intraperitoneal Onlay Mesh ◽

Mesh Reinforcement ◽

Onlay Mesh

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Prophylactic Mesh Placement for the Prevention of Incisional Hernia in High-Risk Patients After Abdominal Surgery: A Systematic Review and Meta-Analysis

Cureus ◽

10.7759/cureus.10491 ◽

2020 ◽

Author(s):

Jawad Ahmed ◽

Nimra Hasnain ◽

Iayla Fatima ◽

Farheen Malik ◽

Muhammad A Chaudhary ◽

...

Keyword(s):

Systematic Review ◽

High Risk ◽

Abdominal Surgery ◽

Incisional Hernia ◽

Meta Analysis ◽

Prophylactic Mesh ◽

Mesh Placement ◽

High Risk Patients ◽

Risk Patients

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Does prophylactic mesh placement in elective, midline laparotomy reduce the incidence of incisional hernia? A systematic review and meta-analysis

Surgery ◽

10.1016/j.surg.2016.09.036 ◽

2017 ◽

Vol 161 (4) ◽

pp. 1149-1163 ◽

Cited By ~ 52

Author(s):

Zachary M. Borab ◽

Sameer Shakir ◽

Michael A. Lanni ◽

Michael G. Tecce ◽

John MacDonald ◽

...

Keyword(s):

Systematic Review ◽

Incisional Hernia ◽

Meta Analysis ◽

Prophylactic Mesh ◽

Midline Laparotomy ◽

Mesh Placement

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Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy

Hernia ◽

10.1007/s10029-013-1119-2 ◽

2013 ◽

Vol 17 (4) ◽

pp. 445-455 ◽

Cited By ~ 49

Author(s):

A. Bhangu ◽

J. E. Fitzgerald ◽

P. Singh ◽

N. Battersby ◽

P. Marriott ◽

...

Keyword(s):

Systematic Review ◽

Incisional Hernia ◽

Meta Analysis ◽

Prophylactic Mesh ◽

Midline Laparotomy ◽

Mesh Placement

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Long-term Follow-Up of Prophylactic Mesh Reinforcement After Emergency Laparotomy. Cohorts Study.

10.21203/rs.3.rs-104602/v1 ◽

2020 ◽

Author(s):

Alejandro Bravo-Salva ◽

Nuria Argudo-Aguirre ◽

Ana María González-Castillo ◽

Estela Membrilla-Fernandez ◽

Joan Sancho-Insenser ◽

...

Keyword(s):

Risk Factors ◽

Incisional Hernia ◽

Long Term Results ◽

Emergency Laparotomy ◽

Prophylactic Mesh ◽

Midline Laparotomy ◽

Incisional Hernias ◽

Mesh Reinforcement

Abstract BackgroundPrevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies. MethodsThis study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared. ResultsFrom an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62% vs. 43.2%; P=0.01) and operation due to a revision laparotomy (32.5% vs. 13%; P=0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P=0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR=2.47; 95% CI 1.318–4.624; P=0.05), contaminated surgery (HR=2.98; 95% CI 1.142–7.8; P=0.02), surgical site infection (SSI; HR=3.83; 95% CI 1.86–7.86; P=0.001), and no use of prophylactic mesh (HR=5.09; 95% CI 2.1–12.2; P=0.001). ConclusionIncidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and SSI benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate.

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