Long-term follow-up of prophylactic mesh reinforcement after emergency laparotomy. A retrospective controlled study
Bravo-Salva, Alejandro (Hospital del Mar (Barcelona, Catalunya))
Argudo, Núria (Hospital del Mar (Barcelona, Catalunya))
González-Castillo, Ana María (Universitat Autònoma de Barcelona. Departament de Ciències Morfològiques)
Membrilla Fernández, Estela (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Sancho Insenser, Joan Josep (Parc de Salut MAR de Barcelona)
Grande, L. (Parc de Salut MAR de Barcelona)
Pera Román, Manuel (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Pereira-Rodríguez, J. A. (Universitat Pompeu Fabra. Departament de Ciències Experimentals i de la Salut)

Date:	2021
Abstract:	Prevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies. This study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared. From an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64. 4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62 vs. 43. 2%; P = 0. 01) and operation due to a revision laparotomy (32. 5 vs. 13%; P = 0. 02) in the M group. During follow-up, 29. 9% of patients developed an incisional hernia (Group S 36. 6% vs. Group M 14. 3%; P = 0. 002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR = 2. 47; 95% CI 1. 318-4. 624; P = 0. 05), contaminated surgery (HR = 2. 98; 95% CI 1. 142-7. 8; P = 0. 02), surgical site infection (SSI; HR = 3. 83; 95% CI 1. 86-7. 86; P = 0. 001), and no use of prophylactic mesh (HR = 5. 09; 95% CI 2. 1-12. 2; P = 0. 001). Incidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and surgical site infection (SSI) benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate. Trial registration: NCT04578561.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Hernia prevention ; Emergency Surgery ; Prophylactic mesh ; Contaminated surgery and long-term follow up
Published in:	BMC Surgery, Vol. 21 (may 2021) , ISSN 1471-2482

DOI: 10.1186/s12893-021-01243-x
PMID: 34006282

8 p, 1.1 MB

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