Does Prophylactic Biologic Mesh Placement Protect Against the Development of Incisional Hernia in High‐risk Patients?

Abstract

The prophylactic use of biologic mesh for abdominal wall closure appears to reduce the incidence of incisional hernia in patients with multiple risk factors for incisional hernia development.

European Hernia Society guidelines on the closure of abdominal wall incisions

“…Pans et al [111] found no significant protective effect on incisional hernia rate by intra-peritoneal augmentation with a polyglactin mesh (Vicryl; Ethicon) on incisional hernia rate in a RCT on obesity surgery (n = 288). Llaguna et al [112] placed a biological mesh (Alloderm; LifeCell) in a retromuscular position in bariatric patients. In this non-randomised comparative study (n = 106 of which 44 with mesh) a significantly lower incisional hernia rate was observed in the mesh group, 2.3 vs 17.7 % (p = 0.014).…”

Incidence and prevention of ventral incisional hernia

“…We selected eight prospective studies published between 2003 and 2011, three of which were randomized, that compared conventional fascial closure with the use of prosthetic mesh [81][82][83][84][85][86]88] (Table 7). Most commonly, polypropylene mesh was used.…”

Cost-utility analysis of the use of prophylactic mesh augmentation compared with primary fascial suture repair in patients at high risk for incisional hernia

“…Such highrisk patients are generally considered to be those with multiple comorbidities, including morbid obesity, diabetes, and hypertension. [14][15][16][17][18][19][20][21][22][23][24][25] This may afford the most effective and cost-efficient strategy, however to date there is no such analysis comparing prophylactic mesh augmentation (PMA) to primary suture repair (PSC) alone from a cost-utility standpoint. Studies have demonstrated relative benefits of PMA in reducing hernia formation after laparotomy in select high-risk patients, particularly in overweight individuals, including recent metaanalyses.…”