Prevention of Incisional Hernia in Ovarian Cancer Patients Undergoing Midline Laparotomy

Abstract

BACKGROUND: Incisional hernias (IH) are a frequent complication of midline laparotomies in abdominal surgery. This study was conducted in order to determine the efficacy of mesh placement and assess the optimal fascia closure technique to reduce the IH rate in patients surgically treated after being diagnosed with malignant or borderline ovarian tumors.METHODS: Retrospective data from patients undergoing midline laparotomy for borderline or ovarian cancer in Hospital del Mar, Barcelona, from January 2008 to December 2019 were collected. Patient demographic, preoperative and intraoperative characteristics and risk factors for hernia were reported. The incidence of IH between groups (mesh and non-mesh) and the technique used in fascial closure for each patient (small bites technique vs large tissue bites) was reported. RESULTS: In total, 133 patients with available data for follow-up were included. After clinical and radiological examination, 25 (18.79%) of them showed IH. 18 of 61(29.5%) patients in non-mesh group developed IH, compared with 7 of 72 (9.7%) in mesh group (OR 0.25, 95% CI 0.09-0.66, p<0.005). Patients of large tissue bites group showed higher prevalence of IH compared with small bites technique group without statistical significance (OR 0.46, 95% CI 0.17-1.24, p=0.119). The combination of mesh reinforcement and small bites technique for fascial closure significantly reduce IH risk (p=0.021). CONCLUSION: Incidence of IH is high in patients undergoing midline laparotomy for ovarian cancer or borderline ovarian tumor. The addition of a prophylactic mesh and use of small bites technique may reduce the incidence of IH and potentially minimize the social impact and costs of this complication.