Implanting intraperitoneal mesh before closure may prevent an incisional hernia in high-risk patients undergoing open abdominal surgery, according to a study published in the journal JAMA Surgery.
An incisional hernia is a common complication of abdominal surgery that impairs quality of life and body image, can result in incarceration, has a high recurrence rate, and is costly to treat.
Dr. Beldi and associates conducted an open-label randomized trial in 150 patients with a median age of 64.2 years undergoing elective open abdominal surgery from 2011 to 2014. Patients were randomly assigned to prophylactic intra-peritoneal implantation or standard abdominal closure.
A double-layered polypropylene-polyvinylidene fluoride mesh (Dynamesh-IPOM, FEG Textiltechnik) was tailored to overlap lateral and cranial-caudal borders by at least 5 cm. The mesh was placed intraperitoneally and fixed to the abdominal wall using single stitches with polypropylene sutures in all 4 corners. After the initial fixation, the borders of the mesh were fixed to the abdominal wall circumferentially using running polypropylene suture to prevent any intestinal structures to herniate onto the mesh.
Follow-up examinations were performed one and three years post-surgery.
The key study findings included are:
- The cumulative incidence of an incisional hernia was 7.2% in the mesh group compared with 18.5% in controls.
- Significantly more patients in the mesh group had abdominal pain at six weeks (65% vs. 44%), but not at 12 or 36 months.
- No difference in surgical site infections was observed, but time to complete healing of such infections was significantly longer in patients with mesh implantation – a median of eight weeks, versus five.
- Further, trunk extension was significantly decreased after mesh implantation compared with controls (mean, 1.73 cm vs. 2.40 cm).
According to Dr. Beldi, the incisional hernia may be prevented by prophylactic mesh implantation but in case of surgical site infection, the wound needs a longer time to heal when compared with patients without mesh implantation.
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