Effectiveness of Prophylactic Intraperitoneal Mesh Implantation for Prevention of Incisional Hernia in Patients Undergoing Open Abdominal Surgery

Köhler, Andreas; Lavanchy, Joël L.; Lenoir, U.; Kurmann, Anita; Candinas, Daniel; Beldi, Guido

doi:10.1001/jamasurg.2018.4221

Cited by 66 publications

(61 citation statements)

References 39 publications

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“…IH remains a significant complication of abdominal incision and carries a considerable morbidity [4]. A recent randomised control trial demonstrated a significant reduction in incidence of IH when mesh was used to close elective laparotomies [41], which is supported by a 2017 meta-analysis [6]. However, evidence suggests an increase in chronic pain, post-operative seroma formation and delayed wound healing with mesh closure of elective laparotomies [6,42].…”

Section: Discussionmentioning

confidence: 99%

Is there a role for prophylactic mesh in abdominal wall closure after emergency laparotomy? A systematic review and meta-analysis

Burns

Heywood

Challand

et al. 2019

Hernia

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Background Incisional hernias are a common complication of emergency laparotomy and are associated with significant morbidity. Recent studies have found a reduction in incisional hernias when mesh is placed prophylactically during abdominal closure in elective laparotomies. This systematic review will assess the safety and efficacy of prophylactic mesh placement in emergency laparotomy. Methods A systematic review was performed according to the PROSPERO registered protocol (CRD42018109283). Papers were dual screened for eligibility, and included when a comparison was made between closure with prophylactic mesh and closure with a standard technique, reported using a comparative design (i.e. case-control, cohort or randomised trial), where the primary outcome was incisional hernia. Bias was assessed using the Cochrane risk of bias in non-randomised studies tool. A meta-analysis of incisional hernia rate was performed to estimate risk ratio using a random effects model (Mantel-Haenszel approach). Results 332 studies were screened for eligibility, 29 full texts were reviewed and 2 non-randomised studies were included. Both studies were biased due to confounding factors, as closure technique was based on patient risk factors for incisional hernia. Both studies found significantly fewer incisional hernias in the mesh groups [3.2% vs 28.6% (p < 0.001) and 5.9% vs 33.3% (p = 0.0001)]. A meta-analysis of incisional hernia risk favoured prophylactic mesh closure [risk ratio 0.15 (95% CI 0.6-0.35, p < 0.001)]. Neither study found an association between mesh and infection or enterocutaneous fistula. Conclusion This review found that there are limited data to assess the effect or safety profile of prophylactic mesh in the emergency laparotomy setting. The current data cannot reliably assess the use of mesh due to confounding factors, and a randomised controlled trial is required to address this important clinical question.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionmentioning

confidence: 99%

Is there a role for prophylactic mesh in abdominal wall closure after emergency laparotomy? A systematic review and meta-analysis

Burns

Heywood

Challand

et al. 2019

Hernia

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“…[16][17][18][19][20][21][22] Studies on prophylactic mesh have either not mentioned the FD incidence or had few cases, preventing the demonstration of a significant difference between the groups with and without mesh. [17][18][19][20][21][23][24][25][26] The reduced number of FDs can be explained because most studies included only patients undergoing elective procedures. 15,16,27 In addition, mesh application is still controversial in emergency laparotomy and in cases of contaminated and infected operations.…”

mentioning

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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“…In Kohler's recent publication there was increased early postoperative pain and prolonged wound healing of surgical site infection in those having mesh. While the pain difference in those who received mesh was confined to the early post-operative period long term trunk extension was reduced in those receiving a mesh [37].…”

Section: Current Limitationsmentioning

confidence: 94%

“…Trunk extension was significantly decreased after mesh implantation compared with the control group. A trend towards increased chronic pain after mesh implantation has been reported in the past [37].…”

Section: Problems With Mesh Insertionmentioning

confidence: 96%

“…Kohler in a recent randomized trial found prophylactic intraperitoneal mesh implantation significantly reduced the incidence of incisional hernia 3 years after laparotomy compared with standard abdominal closure in a high-risk population with IH occurring in 7.2% vs. 18.5% in the non-mesh group [37]. At present there is little evidence on the long-term results of the prophylactic use of mesh, but the protective effect of the use of an onlay mesh in abdominal wall closure is maintained for at least up to 5 years after surgery.…”

Section: Which Position Should the Mesh Be Placed?mentioning

confidence: 99%

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

Sugrue

Johnston

Zeeshan

et al. 2019

ait

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Effectiveness of Prophylactic Intraperitoneal Mesh Implantation for Prevention of Incisional Hernia in Patients Undergoing Open Abdominal Surgery

Cited by 66 publications

References 39 publications

Is there a role for prophylactic mesh in abdominal wall closure after emergency laparotomy? A systematic review and meta-analysis

Is there a role for prophylactic mesh in abdominal wall closure after emergency laparotomy? A systematic review and meta-analysis

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

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

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