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Published on: December 23, 2022
Incisional hernia prevention in high-risk midline laparotomy using onlay PVDF mesh: multicenter prospective
Jose Luis Rodicio Miravalles1, Javier López Monclús2, Sonia Amoza Pais1
1Division of General Surgery, Hospital Universitario de Cabueñes, Gijón, Spain.
Introduction:
Prophylactic mesh reinforcement reduces the risk of incisional hernia after midline laparotomy in high-risk patients, although concerns regarding complications and implementation limit its routine use. This multicentre prospective observational study evaluated long-term outcomes after onlay polyvinylidene fluoride (PVDF) mesh reinforcement in high-risk patients undergoing midline laparotomy in elective and emergency settings.
Materials And Methods:
A prospective multicentre observational cohort study was conducted in tertiary and secondary hospitals within the Spanish National Health Service between July 2016 and June 2022. Adult patients undergoing midline laparotomy with more than one risk factor for incisional hernia were included. Abdominal wall closure was reinforced with an onlay PVDF mesh visible on MRI. The primary outcome was incisional hernia at 2 years. Secondary outcomes included mesh-related complications and factors associated with incisional hernia.
Results:
A total of 180 patients were analysed. Mean age was 64.6 years and mean BMI was 27.4 kg/m2. Most procedures were performed for oncological disease (72.8%), 32.8% were emergency operations, and 23.9% were performed in contaminated or dirty surgical fields. Surgical-site infection occurred in 12.8% and seroma in 9.4% during index admission. Mesh removal was required in four patients (2.2%). Two-year follow-up among surviving patients reached 96.1%. In the intention-to-treat analysis, incisional hernia developed in 21 patients (11.3%), compared with 16 patients (8.9%) in the per-protocol analysis. BMI (OR 1.19, 95% c.i. 1.05 to 1.33; P = 0.008) and stoma formation (OR 5.77, 95% c.i. 1.75 to 19.30; P = 0.004) were independently associated with incisional hernia. MRI demonstrated no significant mesh contraction.
Conclusion:
In this prospective multicentre observational study, prophylactic onlay PVDF mesh reinforcement in high-risk midline laparotomy, including emergency and contaminated procedures, was feasible and associated with a low incidence of incisional hernia and acceptable mesh-related morbidity. These findings are hypothesis-generating and warrant further evaluation in controlled studies.
