Article (Scientific journals)
Prevention of Incisional Hernias by Prophylactic Mesh-augmented Reinforcement of Midline Laparotomies for Abdominal Aortic Aneurysm Treatment 5-year Follow-up of a Randomized Controlled Trial.
Dewulf, Maxime; Muysoms, Filip; Vierendeels, Tijl et al.
2022In Annals of Surgery, 276 (4), p. 217-e222
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Keywords :
Surgery; hernia; complication; prevention; mesh; laparotomy
Abstract :
[en] INTRODUCTION: The incidence of incisional hernias (IHs) after open repair of an abdominal aortic aneurysm (AAA) is high. Several randomized controlled trials have reported favorable results with the use of prophylactic mesh to prevent IHs, without increasing complications. In this analysis we report on the results of the 60-month follow-up of the PRIMAAT trial (Ann Surg 2016; 263(4): 638-45). METHODS: In a prospective, multicenter, open label, randomized design, patients were randomized between prophylactic retrorectus mesh reinforcement (MESH group), and primary closure of their midline laparotomy after open AAA repair (NOMESH group). This article reports on the results of clinical follow-up after 60 months. If performed, ultrasonography or computed tomography were used for the diagnosis of IHs. RESULTS: Of the 120 randomized patients, 114 were included in the intention-to-treat analysis. Thirty-three patients in the NOMESH group (33/58-56.9%) and 34 patients in the MESH group (34/56-60.7%) were evaluated after 5 years. In each treatment arm, 10 patients died between the 24-month and 60-month follow-up. The cumulative incidence of IHs in the NOMESH group was 32.9% after 24 months and 49.2% after 60 months. No incisional hernias were diagnosed in the MESH group. In the NOMESH group, 21.7% (5/23) underwent reoperation within 5 years due to an IH. CONCLUSION: Prophylactic retrorectus mesh reinforcement after midline laparotomy for the treatment of AAAs safely and effectively decreases the rate of IHs. The cumulative incidence of IHs after open AAA repair, when no mesh is used, continues to increase during the first 5 years after surgery, which leads to a substantial rate of hernia repairs.
Disciplines :
Surgery
Author, co-author :
Dewulf, Maxime;  Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
Muysoms, Filip;  Department of Surgery, Maria Middelares Hospital Ghent, Belgium
Vierendeels, Tijl;  Department of Surgery, ASZ Hospital, Aalst, Belgium
Huyghe, Marc;  Department of Surgery, Sint-Augustinus Hospital, Antwerp, Belgium
Miserez, Marc;  Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
Ruppert, Martin;  Department of Surgery, University Hospital Antwerp, Edegem, Belgium
Tollens, Tim;  Department of Surgery, Imelda Hospital Bonheiden, Bonheiden, Belgium
van Bergen, Liesbeth;  Department of Surgery, University Hospital Antwerp, Edegem, Belgium
Berrevoet, Frederik;  Department of General and HPB Surgery, Ghent University Hospital, Ghent, Belgium
DETRY, Olivier  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation
Language :
English
Title :
Prevention of Incisional Hernias by Prophylactic Mesh-augmented Reinforcement of Midline Laparotomies for Abdominal Aortic Aneurysm Treatment 5-year Follow-up of a Randomized Controlled Trial.
Publication date :
28 October 2022
Journal title :
Annals of Surgery
ISSN :
0003-4932
eISSN :
1528-1140
Publisher :
Ovid Technologies (Wolters Kluwer Health), United States
Volume :
276
Issue :
4
Pages :
e217-e222
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 12 July 2022

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