Synthetic mesh versus biological mesh to prevent incisional hernia after loop-ileostomy closure: a randomized feasibility trial

Abstract

Background Incisional hernia is a frequent complication after loop-ileostomy closure, rationalizing hernia prevention. Biological meshes have been widely used in contaminated surgical sites instead of synthetic meshes in fear of mesh related complications. However, previous studies on meshes does not support this practice. The aim of Preloop trial was to study the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure. Methods The Preloop randomized, feasibility trial was conducted from April 2018 until November 2021 in four hospitals in Finland. The trial enrolled 102 patients with temporary loop-ileostomy after anterior resection for rectal cancer. The study patients were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene Macro™, Medtronic) (SM) or a biological mesh (Permacol™, Medtronic) (BM) to the retrorectus space at ileostomy closure. The primary end points were rate of surgical site infections (SSI) at 30-day follow-up and incisional hernia rate during 10 months’ follow-up period. Results Of 102 patients randomized, 97 received the intended allocation. At 30-day follow-up, 94 (97%) patients were evaluated. In the SM group, 1/46 (2%) had SSI. Uneventful recovery was reported in 38/46 (86%) in SM group. In the BM group, 2/48 (4%) had SSI (p > 0.90) and in 43/48 (90%) uneventful recovery was reported. The mesh was removed from one patient in both groups (p > 0.90). Conclusions Both a synthetic mesh and biological mesh were safe in terms of SSI after loop-ileostomy closure. Hernia prevention efficacy will be published after the study patients have completed the 10 months’ follow-up.

Outcomes and Quality of Life After Resorbable Synthetic Ventral Hernia Repair in Contaminated Fields

“…Despite concerns with synthetic mesh, Rosen et al 11 have successfully demonstrated that it can be considered in contaminated VHR when placed in the retromuscular position with superior outcomes to biologic mesh. Other studies reflect this shift toward using synthetic mesh in certain contaminated environments 29,32–34 . Our results demonstrate that the use of biosynthetic mesh shows similar outcomes to synthetic mesh, making P4HB a viable option for surgeons due to its relatively low infection rates and sustained QoL improvement.…”

“…Other studies reflect this shift toward using synthetic mesh in certain contaminated environments. 29,[32][33][34] Our results demonstrate that the use of biosynthetic mesh shows similar outcomes to synthetic mesh, making P4HB a viable option for surgeons due to its relatively low infection rates and sustained QoL improvement.…”

Reinforced tissue matrix to strengthen the abdominal wall following reversal of temporary ostomies or to treat incisional hernias

“…, low rates of incisional hernia and no surgical site infection)[ 12 , 15 ]. Results have compared favorably to synthetic mesh repairs[ 16 ] and direct tissue repair[ 17 ]. A large randomized controlled trial of 790 patients undergoing elective ileostomy or colostomy closure were assigned to receive suture alone or biologic mesh augmented stoma takedown.…”