PREBIOUS trial: A multicenter randomized controlled trial of PREventive midline laparotomy closure with a BIOabsorbable mesh for the prevention of incisional hernia: Rationale and design

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

“…Known characteristics of an ideal mesh include inert material, mechanical strain resistance, minimal foreign body reaction, flexibility, infection resistance, protection against visceral adhesion formation, and similar tensile strength to autologous tissue. Several mesh types, including permanent synthetic, 17,[19][20][21]25,28 biologic, 24 and bioabsorbable 46 meshes have demonstrated effectiveness, yet no one type offers the optimal combination of characteristics. Identifying the best mesh type and location in the prophylactic versus hernia setting poses a unique set of challenges that remains unstudied.…”

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

“…During analysis significantly (P = 0.002) more seromas were detected after OMA (n = 34, 18.1%) compared with primary suture (n = 5, 4.7%) and sublay mesh augmentation (n = 13, 7.0%). No differences were seen in surgical site infection, hematoma, reintervention, or readmission [35].…”

“…There is no evidence that, in this setting, a non-permanent absorbable biological or biosynthetic mesh would be preferred to synthetic non-absorbable mesh, both in clean or clean-contaminated surgery [34]. Furthermore, the on-going PREBIOUS trial is attempting to determine the efficacy of bioabsorbable meshes [35]. The potential attraction of bioabsorbable meshes is that they behave like synthetics with good tensile strength but eventually reabsorb which could lead to less chronic pain and a possible decreased infection risk.…”

“…There is a growing body of literature on the efficacy of bioabsorbable meshes for a similar purpose as well as on-going clinical studies such as the PREBIOUS trial [35,40]. While Choi et al in a study of the adverse effect of mesh in clean and clean contaminated ventral hernia repair expressed caution about its use; their study is somewhat dated and without information on the type of mesh or the primary surgery [41].…”

Contemporary concepts in hernia prevention: Selected proceedings from the 2017 International Symposium on Prevention of Incisional Hernias

“…The PREBIOUS (PREventive midline laparotomy closure with a BIOabsorbable mesh) trial is an active, randomized, control trial examining the potentially beneficial effects of reinforcing a midline laparotomy incision with a bioabsorbable (GORE BIO-A; W. L. Gore & Associates, Inc, Flagstaff, AZ) prosthetic. 17 The prophylactic strategy of inserting a bioabsorbable prosthetic between the healing edges of the midline fascia has been successfully demonstrated in a preclinical study in rodents. 18 At present, the PREBIOUS trial has recruited approximately 250 patients undergoing both elective and emergency abdominal surgery.…”