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Long-term outcome with the prophylactic use of polypropylene mesh in morbidly obese patients undergoing
Giuseppe Curro1, Tommaso Centorrino, Vanessa Low
1Department of Human Pathology, University of Messina, Messina, Italy. currog@unime.it
Insights
Prophylactic mesh closure in bariatric surgery significantly reduced incisional hernias. This study found polypropylene mesh safe and effective for morbidly obese patients undergoing biliopancreatic diversion.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Devices
Background:
- Incisional hernia prevention in bariatric surgery using prosthetic material is debated.
- Morbidly obese patients undergoing biliopancreatic diversion are at high risk for incisional hernias.
Purpose of the Study:
- To evaluate the safety and efficacy of polypropylene mesh for preventing incisional hernias.
- To compare hernia rates between mesh closure and conventional closure in open bariatric surgery.
Main Methods:
- Retrospective analysis of 95 morbidly obese patients undergoing open biliopancreatic diversion.
- Comparison of 45 patients with mesh closure versus 50 patients with conventional closure.
- Minimum 2-year follow-up assessing hernia incidence and complications.
Main Results:
- No mesh infections were reported.
- Similar minor local complications in both groups.
- Significantly lower incisional hernia rate (4.4%) in the mesh group compared to the conventional group (30%) at 2-year follow-up (p < 0.05).
Conclusions:
- Prophylactic polypropylene mesh use is safe and effective in reducing incisional hernias.
- Mesh closure offers a significant benefit for morbidly obese patients undergoing open bariatric procedures.
- This approach improves patient outcomes by lowering hernia complication rates.
Abstract:
The use of prosthetic material to prevent incisional hernia in clean-contaminated procedures as bariatric surgery remains controversial. We present our experience on 45 consecutive morbidly obese patients undergoing biliopancreatic diversion that was closed using a polypropylene mesh. Moreover, we reviewed the outcome of the 50 previous consecutive obese patients who underwent biliopancreatic diversion and conventional closure of the abdomen in order to compare the outcome between the two groups after a minimum follow-up of 2 years. Between January 2006 and February 2010, 95 morbidly obese patients underwent open biliopancreatic diversion at our department. During the first 2 years of our experience, there were 50 obese patients whose open biliopancreatic diversion was closed conventionally (without mesh). Starting on February 2008 and until February 2010, 45 patients received prophylactic midline reinforcement by the positioning of retrorectal muscle polypropylene mesh. The outcome at 3, 6, 12, and 24 months was analyzed comparing the two groups of patients. No mesh infection occurred. Minor local complications occurred similarly in both groups. The incidence of postoperative hernia was significantly higher in the group conventionally closed (30%) than in the mesh group (4.4%) at 2-year follow-up (p < 0.05). The prophylactic use of mesh in open bariatric surgery is safe and effective at 2-year follow-up.
