Abdominal wall closure with prophylactic mesh in colorectal operations

Area of Science:

• Colorectal Surgery
• Surgical Innovation
• Hernia Prevention

Background:

• Incisional hernias (IHs) affect over one-third of patients after standard laparotomy closure.
• Prophylactic mesh reduces IH rates in clean wounds but has concerns regarding seroma, infection, and pain.
• High IH rates in a colorectal surgeon's practice prompted routine prophylactic mesh use in high-risk patients.

Purpose of the Study:

• To review the outcomes of prophylactic mesh placement in high-risk patients undergoing colorectal surgery.
• To evaluate the efficacy and safety of prophylactic mesh in preventing incisional hernias.

Main Methods:

• Retrospective analysis of 935 colorectal procedures (bowel resection and ileostomy closure) performed by a single surgeon from 2008 to 2018.
• Comparison of outcomes between patients who received prophylactic mesh (n=221) and those who did not (n=714).

Main Results:

• Incisional hernias occurred in 1.3% of the mesh group versus 13.3% in the non-mesh group (P < .0001).
• Seroma rates were higher in the mesh group (4.1% vs 0.8%, P = .003).
• Chronic pain rates were also higher in the mesh group (5.4% vs 2.4%, P = .04).
• Wound infection rates were similar between groups (4.1% vs 3.2%, P = .53).

Conclusions:

• Prophylactic mesh significantly reduces incisional hernia rates in colorectal operations.
• The observed complication rates, including seroma and chronic pain, did not prove prohibitive.
• Routine prophylactic mesh placement is a viable strategy for preventing IHs in high-risk colorectal surgery patients.