|
Title
|
|
|
|
Prevention of Incisional Hernias by Prophylactic Mesh-augmented Reinforcement of Midline Laparotomies for Abdominal Aortic Aneurysm Treatment: A Randomized Controlled Trial
| |
|
Author
|
|
|
|
| |
|
Abstract
|
|
|
|
| Background:The incidence of incisional hernias after abdominal aortic aneurysm repair is high. Prophylactic mesh-augmented reinforcement during laparotomy closure has been proposed in patients at high risk of incisional hernia.Methods:A multicenter randomized trial was conducted on patients undergoing elective abdominal aortic aneurysm repair through a midline laparotomy (Clinical.Trials.gov: NCT00757133). In the study group, retromuscular mesh-augmented reinforcement was performed with a large-pore polypropylene mesh (Ultrapro, width 7.5cm). The primary endpoint was the incidence of incisional hernias at 2-year follow-up.Results:Between February 2009 and January 2013, 120 patients were recruited at 8 Belgian centers. Patients' characteristics at baseline were similar between groups. Operative and postoperative characteristics showed no difference in morbidity or mortality. The cumulative incidence of incisional hernias at 2-year follow-up after conventional closure was 28% (95% confidence interval [CI], 17%-41%) versus 0% (95% CI, 0%-6%) after mesh-augmented reinforcement (P < 0.0001; Fisher exact test). The estimated freedom of incisional hernia curves (Kaplan-Meier estimate) were significantly different across study arms ((2) = 19.5, P < 0.0001; Mantel-Cox test). No adverse effect related to mesh-augmented reinforcement was observed, apart from an increased mean time to close the abdominal wall for mesh-augmented reinforcement compared with the control group: 46 minutes (SD, 18.6) versus 30 minutes (SD, 18.5), respectively (P < 0.001; Mann-Whitney U test).Conclusions:Prophylactic retromuscular mesh-augmented reinforcement of a midline laparotomy in patients with abdominal aortic aneurysm is safe and effectively prevents the development of incisional hernia during 2 years, with an additional mean operative time of 16 minutes. |
| |
|
Language
|
|
|
|
English
| |
|
Source (journal)
|
|
|
|
Annals of surgery. - Philadelphia, Pa, 1885, currens
| |
|
Publication
|
|
|
|
Philadelphia, Pa
:
2016
| |
|
ISSN
|
|
|
|
0003-4932
1528-1140
[online]
| |
|
DOI
|
|
|
|
10.1097/SLA.0000000000001369
| |
|
Volume/pages
|
|
|
|
263
:4
(2016)
, p. 638-645
| |
|
ISI
|
|
|
|
000374782700013
| |
|
Full text (Publisher's DOI)
|
|
|
|
| |
|