PREVENTION OF INCISIONAL HERNIA AFTER MIDLINE LAPAROTOMY FOR ABDOMINAL AORTIC ANEURYSM TREATMENT: A RANDOMIZED CONTROLLED TRIAL

Background:
The incidence of incisional hernias (IH) after open abdominal aortic aneurysm (AAA) repair is high. Prophylactic mesh augmentation (PMA) during laparotomy closure has been proposed in high-risk patients.
Methods:
A multicenter prospective randomized controlled study was conducted on patients undergoing elective repair of AAA through midline laparotomy (Clinical.Trials.gov: NCT00757133). In the study group a retro-muscular PMA was performed with a large-pore polypropylene mesh (Ultrapro™, width 7.5 cm). The primary endpoint was the incidence of IH at 24 months.
Results:
Between February 2009 and January 2013, 120 patients were recruited at 8 Belgian centers. Patients' characteristics at baseline were similar between the groups. Operative and postoperative characteristics showed no difference in morbidity or mortality. A highly significant reduction of IH incidence was found after PMA compared to conventional closure, respectively 0% (CI: 0 % - 5.5%) versus 27.6% (CI: 16.7% - 40.9%) (P<0.0001; Fisher's exact test). The estimated "freedom of IH" curves (Kaplan-Meier estimate) were significantly different across study arms (X2=18.93, P<0.0001; Mantel-Cox test). No adverse effects were observed, apart from an increased mean (SD) time to close the abdominal wall for PMA: 46.2 min (18.6) versus 29.6 min (18.5) (P<0.001; Mann-Whitney U test).
Conclusion:
Prophylactic retro-muscular mesh augmentation of a midline laparotomy in AAA patients is safe and effectively prevents the development of IH, with an extra time investment of 17 minutes.