Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients

Incisional hernia is one of the major elements of morbidity after abdominal surgery, with high incidence in vertical midline abdominal incisions. However, the risk of developing an incisional hernia can be increased due to the patient's related factors; therefore, more consideration has to be given to the choice of incision, wound closure and wound healing to protect against incisional hernia, especially in high-risk patients. In this study, we used prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients to detect whether fixing the wound with mesh is risky on a short-term basis and whether it is protective on a long-term basis.

From October 2000 to December 2002, 40 high-risk patients liable to develop postoperative incisional hernia underwent elective abdominal operations through midline abdominal incisions at the Department of Surgery, Gastroenterology and Laparoscopic Unit, Tanta University Hospital, Egypt. They were randomly divided into two groups; group A: patients for whom the midline abdominal incisions were closed by conventional method and reinforced by subfascial polypropylene mesh (20 patients); and group B: patients for whom the midline abdominal incisions were closed by conventional method only (20 patients) with a follow up period of more than 20 months.

There was no significant difference (P = 0.075) in both groups regarding the age, sex and the average risk factor. Twenty-three patients (57.5%) presented with more than one risk factor (11 in group A and 12 in group B). The upper midline abdominal incisions were reported in 33 patients (19 upper and 14 extended upper). There was no significant difference between the overall local and systemic complications in both groups (P = 0.4082). However, the subcutaneous seroma and chronic wound pain were greater in patients with prophylactic mesh than those without mesh. One group A patients (5%) and three group B patients (15%) developed postoperative incisional hernia during the follow up period.

Prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients can be used safely and effectively to provide extrinsic strength of the wound without relying too much on the defective development of its own intrinsic strength and to prevent subsequent incisional hernia. There was no risk in the use of the mesh regarding local and systemic complication. However, the final statement should await the outcomes of the long-term follow up of the studied cases.