Randomized clinical trial of mesh <i>versus</i> sutured wound closure after open abdominal aortic aneurysm surgery

Bevis, Paul; Windhaber, R A J; Lear, P. A.; Poskitt, K. R.; Earnshaw, J. J.; Mitchell, David C.

doi:10.1002/bjs.7137

Cited by 155 publications

(71 citation statements)

References 18 publications

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“…Two studies reported data on operation time [35,36]; however, as the study by Bevis et al [35] did not report standard deviations, these results could not be pooled. Bevis et al [35] reported no statistically significant difference in median duration of operation (min) between the PMA group and the PS group (150 min, range 90-225 vs. 140 min, range 90-300; p = 0.59).…”

Section: Resultsmentioning

confidence: 39%

“…The study by Bevis et al [35] was the only study that performed a power analysis prior to the start of trial. Unfortunately, they were not able to reach the number of patients calculated, and thus the study remained underpowered.…”

Section: Discussionmentioning

confidence: 99%

“…Bevis et al [35] reported no statistically significant difference in median duration of operation (min) between the PMA group and the PS group (150 min, range 90-225 vs. 140 min, range 90-300; p = 0.59). Abo-Ryia et al [36] also discovered no statistically significant difference in mean duration of their operations between the PMA group and the PS group (vertical banded gastroplasty: 81.2 min, SD 7 vs. 76.2 min, SD 9; Roux-en-Y gastric bypass: 151 min, SD 9 vs. 144.9 min, SD 9; vertical sleeve gastrectomy: 123.5 min, SD 8 vs. 115.1 min, SD 5).…”

Section: Resultsmentioning

confidence: 99%

“…Five studies (n = 346 patients) investigated pooled occurrence of IH and were included in the meta-analysis [32,33,34,35,36]. IH occurred significantly less in the PMA group (RR 0.25, 95% CI 0.12-0.52, I 2 0%; p < 0.001; fig.…”

Section: Resultsmentioning

confidence: 99%

“…In three studies [32,34,36], no description of blinding was described, and it is likely that the personnel were not blinded during follow-up. Bevis et al [35] describe that patients were blinded but that surgeons during follow-up had access to full patient notes. All three studies are at risk for detection bias.…”

Section: Discussionmentioning

confidence: 99%

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Meta-Analysis of Primary Mesh Augmentation as Prophylactic Measure to Prevent Incisional Hernia

Timmermans¹,

Goede²,

Eker³

et al. 2013

Dig Surg

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Background: Incisional hernia (IH) remains one of the most frequent postoperative complications after abdominal surgery. As a consequence, primary mesh augmentation (PMA), a technique to strengthen the abdominal wall, has been gaining popularity. This meta-analysis was conducted to evaluate the prophylactic effect of PMA on the incidence of IH compared to primary suture (PS). Methods: A meta-analysis was conducted according to the PRISMA guidelines. Randomized controlled trials (RCTs) comparing PMA and PS for closing the abdominal wall after surgery were included. Results: Out of 576 papers, 5 RCTs were selected comprising 346 patients. IH occurred significantly less in the PMA group (RR 0.25, 95% CI 0.12-0.52, I²0%; p < 0.001). No difference could be observed with regard to wound infection (RR 0.86, 95% CI 0.39-1.91, I² 0%; p = 0.71) or seroma (RR 1.22, 95% CI 0.64-2.33, I² 0%; p = 0.55). A trend was observed for chronic pain in favor of the PS group (RR 5.95, 95% CI 0.74-48.03, I²0%; p = 0.09). Conclusion: The use of PMA for abdominal wall closure is associated with significantly lower incidence of IH compared to PS.

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Section: Resultsmentioning

confidence: 39%

Section: Discussionmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Meta-Analysis of Primary Mesh Augmentation as Prophylactic Measure to Prevent Incisional Hernia

Timmermans¹,

Goede²,

Eker³

et al. 2013

Dig Surg

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

et al. 2019

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is a frequent complication after open abdominal surgery. Prophylactic mesh implantation in the onlay or sublay position requires dissection of the abdominal wall, potentially leading to wound-associated complications. OBJECTIVE To compare the incidence of incisional hernia among patients after prophylactic intraperitoneal mesh implantation with that among patients after standard abdominal closure. DESIGN, SETTING, AND PARTICIPANTS An open-label randomized clinical trial was performed in 169 patients undergoing elective open abdominal surgery from January 1, 2011, to February 29, 2014. Follow-up examinations were performed 1 year and 3 years after surgery. The study was conducted at

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Incidence, Burden on the Health Care System, and Factors Associated With Incisional Hernia After Trauma Laparotomy

et al. 2021

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IMPORTANCEThe evidence provided supports routine and systematic capture of long-term outcomes after trauma, lengthening the follow-up for patients at risk for incisional hernia (IH) after trauma laparotomy (TL), counseling on the risk of IH during the postdischarge period, and consideration of preventive strategies before future abdominal operations to lessen IH prevalence as well as the patient and health care burden.OBJECTIVE To determine burden of and factors associated with IH formation following TL at a population-based level across health care settings. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included adult patients who were admitted with traumatic injuries and underwent laparotomy with follow-up of 2 or more years. The study used 18 statewide databases containing data collected from January 2006 through December 2016 and corresponding to 6 states in diverse regions of the US. Longitudinal outcomes were identified within the Statewide Inpatient, Ambulatory, and Emergency Department Databases. Patients admitted with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for traumatic injuries with 1 or more concurrent open abdominal operations were included. Data analysis was conducted from March 2020 through June 2020. MAIN OUTCOMES AND MEASURES The primary outcome was IH after TL. Risk-adjusted Cox regression allowed identification of patient-level, operative, and postoperative factors associated with IH. RESULTS Of 35 666 patients undergoing TL, 3127 (8.8%) developed IH (median [interquartile range] follow-up, 5.6 [3.4-8.6] years). Patients had a median age of 49 (interquartile range, 31-67) years, and most were male (21 014 [58.9%]), White (21 584 [60.5%]), and admitted for nonpenetrating trauma (28 909 [81.1%]). The 10-year IH rate and annual incidence were 11.1% (95% CI, 10.7%-11.5%) and 15.6 (95% CI, 15.1-16.2) cases per 1000 people, respectively. Within risk-adjusted analyses, reoperation (adjusted hazard ratio [aHR], 1.28 [95% CI, 1.2-1.37]) and subsequent abdominal surgeries (aHR, 1.71 [95% CI,), as well as obesity (aHR, 1.88 [95% CI, 1.69-2.10]), intestinal procedures (aHR, 1.47 [95% CI, 1.36-1.59]), and public insurance (aHRs: Medicare, 1.38 [95% CI, 1.20-1.57]; Medicaid, 1.35 [95% CI, 1.21-1.51]) were among the variables most strongly associated with IH. Every additional reoperation at the index admission and subsequently resulted in a 28% (95% CI, 20%-37%) and 71% (95% CI, 56%-88%) increased risk for IH, respectively. Repair of IH represented an additional $36.1 million in aggregate costs (39.9%) relative to all index TL admissions.CONCLUSIONS AND RELEVANCE Incisional hernia after TL mirrors the epidemiology and patient profile characteristics seen in the elective setting. We identified patient-level, perioperative, and novel postoperative factors associated with IH, with obesity, intestinal procedures, and repeated disruption of the abdominal wall among the factors most strongly associated with this outcome. These data suppo...

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Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery

Abstract: Mesh placement significantly reduced the rate of postoperative incisional hernia after open AAA repair without increasing the rate of complications.

Cited by 155 publications

References 18 publications

Meta-Analysis of Primary Mesh Augmentation as Prophylactic Measure to Prevent Incisional Hernia

Meta-Analysis of Primary Mesh Augmentation as Prophylactic Measure to Prevent Incisional Hernia

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

Incidence, Burden on the Health Care System, and Factors Associated With Incisional Hernia After Trauma Laparotomy

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