Long-term results of a prospective randomized trial of midline laparotomy closure with onlay mesh

Caro, Aleidis; Olona, Carles; Millán, Mònica; Olona, Montserrat; Espina, Beatriz; Jorba, Rosa

doi:10.1007/s10029-019-01891-2

Cited by 31 publications

(40 citation statements)

References 27 publications

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“…Some studies of prophylactic mesh have performed fascial suturing without concern for the SL/WL ratio, 24,26,33 and others have indicated that the target should be an SL/WL ratio !4.0, but did not measure the actual value achieved. 17,20,23,25,54,55 In practice, achieving this goal is not a simple task. Even if the small-bite technique is performed perfectly, an excessive pull of the thread, for example, can reduce the relation reached.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Lima

Rasslan

Novo

et al. 2020

Journal of the American College of Surgeons

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BACKGROUND: Fascial dehiscence (FD) occurs in up to 14.9% of high-risk patients undergoing emergency laparotomy. Although prophylactic mesh can prevent FD, its use in emergency operations remains controversial. STUDY DESIGN: A prospective randomized clinical trial was conducted at the Hospital das Clínicas from Faculdade de Medicina da Universidade de São Paulo in Brazil. It was performed among highrisk patients, defined according to Rotterdam risk model, undergoing midline emergency laparotomy. The patients were randomized into the suture group (SG), with slowly absorbable running sutures placed with a 36-mm-long needle at a suture-to-wound length ratio of 4:1, and the prophylactic mesh group (PMG), with fascial closure as in the SG but reinforced with onlay polypropylene mesh. The primary end point was incidence of FD at 30 days post operation. RESULTS: We analyzed 115 patients; 52 and 63 were allocated to the SG and PMG, respectively. In all, 77.4% of the cases were for colorectal resection. FD occurred in 7 (13.5%) patients in the SG and none in the PMG (p ¼ 0.003). There was no difference between the groups in number of patients with surgical site occurrence (SSO) or SSO requiring procedural intervention. However, some specific SSOs had higher incidences in the mesh group: surgical site infection (20.6% versus 7.7%; p ¼ 0.05), seroma (19.0% versus 5.8%; p ¼ 0.03), and nonhealing incisional wound (23.8% versus 5.8%; p ¼ 0.008). Of SSOs in the PMG and SG, 92.3% and 73.3%, respectively, resolved spontaneously or with bedside interventions. CONCLUSIONS: Prophylactic onlay mesh reinforcement in emergency laparotomy is safe and prevents FD. Surgical site infection, seroma, and nonhealing incisional wound were more common in the mesh group, but associated with low morbidity within 30 days post operation.

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Section: Discussionmentioning

confidence: 99%

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Lima

Rasslan

Novo

et al. 2020

Journal of the American College of Surgeons

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“…Prophylaxis strategies range from the modification of the surgical technique, as reported in the study by Lozada et al In 2016 [10], in which an abdominal wall reinforcement was performed with the RTL technique, reducing the presence of this complication from 20 to 4.5%. Most current studies are focused on the use of mesh prophylactically and report an overall incidence with its use of 9% [2,[4][5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…In patients at elevated risk for IH, prophylactic mesh implantation reduces the incidence of hernia formation, but with increased early postoperative pain and prolonged wound healing of surgical site infection [2,[4][5][6][7][8][9]. To maximize the benefit-risk ratio, despite technical modifications or prophylactic mesh implantation would ideally be performed in patients at elevated risk for hernia development.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Two Predictive Scores for the Development of Incisional Hernia

Hernández¹,

Gonzalez²,

Rodriguez³

et al. 2019

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Introduction: Incisional Hernia (IH) is a frequent complication of abdominal surgery, with an incidence of 10-23%, which can increase to 38% in specific risk groups. So far there is no ideal method to identify patients at high risk of developing IH, this variety in the criteria of inclusion of patients in different studies makes is very complicate to compare the results. The aim of this study is comparing the two predictive scores of incisional hernias (Hernia project Vs Van Ramshorst) with higher diagnostic performance and determine which is better to predict IH. Methods: An analytical, observational study was conducted between June and December 2018, in patients of both sexes, who were 18 years or older, undergoing midline laparotomy, regardless of their background diagnosis either urgently or scheduled between 2007 to 2016. The two different classifications, the Hernia Project score and Van Ramshorst score, were applied to each of the patients. With the identification of patients with hernia, two groups, healthy and ill, were performed and Bayesian statistics were made with it and to identify which scale best predicts the presence of this complication. Results: The records of 1085 patients undergoing midline laparotomy were reviewed. 296 patients were ruled out because their follow-up was not complete. Both tests were compared to determine the best diagnostic performance using the ROC curve and the area under the curve, finding that the Hernia Project Score has a larger area 0.724 compared to a 0.663 of Van Ramshorst. Discussion: In our patient cohort, the Hernia Project score has a greater predictive capacity, with an area under the best curve (0.72 vs. 0.66) however both They have a poor sensitivity and this is the main measure of the predictive capacity of any diagnostic test, so with these results, we can affirm that the Project hernia scale has a greater diagnostic capacity than the Van Ramshorst scale but still its diagnostic capacity is limited. Conclusions: Both scores have low sensitivity. We can affirm that the Hernia Project score has a greater diagnostic capacity than the Van Ramshorst score, but both have a limited diagnostic capacity.

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“…This is especially common in patients undergoing open bariatric surgery and abdominal aneurysm repair. The incidence of IH is approximately 11%-20% in patients post laparotomy, but it can be as high as 39.9% in high-risk populations such as obesity, prior abdominal operation, abdominal aortic aneurysm, or patients suffering from neoplastic diseases [1][2][3][4]. Annually, 150,000 patients are operated for IH in the United States alone, with one-third repairs occurring within nine years.…”

Section: Introductionmentioning

confidence: 99%

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

Ahmed¹,

Hasnain²,

Fatima³

et al. 2020

Cureus

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Long-term results of a prospective randomized trial of midline laparotomy closure with onlay mesh

Cited by 31 publications

References 27 publications

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Comparison of Two Predictive Scores for the Development of Incisional Hernia

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

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