A Systematic Review and Independent Patient Data Meta-Analysis of Prophylactic Mesh Augmentation for Incisional Hernia Prevention after Abdominal Aortic Aneurysm Surgery (I-PREVENT-AAA) A Collaborative European Hernia Society Project.
van den Berg, Rudolf; Den Hartog, Floris P J; Baart, Sara Jet al.
[en] [en] OBJECTIVE: To analyze the effectiveness of prophylactic mesh augmentation (PMA) of the abdominal wall following open aortic aneurysm repair as compared to primary sutured closure in preventing incisional hernia (IH) formation by performing an individual patient-data meta-analysis (IPDMA).
SUMMARY BACKGROUND DATA: IH is a prevalent complication after abdominal surgery, especially in high-risk groups. PMA of the abdominal wall has been studied as a preventive measure for IH-formation, but strong recommendations are lacking.
METHODS: A systematic literature search was conducted till 23 September 2024 to identify randomized controlled trials (RCTs) that compared PMA with PS after open AAA surgery. Lead authors of eligible studies were asked to share individual patient-data. A one-stage analysis was performed, and Cox-regression analyses were used to assess time-to-event outcomes.
RESULTS: Five randomized trials with a total of 493 patients were included. Intention to treat analysis revealed that PMA was associated with significantly lower risk of IH (hazard ratio of 0.25 (95% CI 0.12-0.50)) as compared to PS closure. Three-year incisional hernia rates were 13.2% and 39.6%, respectively, with a number needed to treat of 3.7. The effect was similar for onlay and retro-rectus PMA. PMA resulted in longer operative time (mean 27 minutes) and more seroma formation (especially onlay PMA) but did not increase the risk of surgical site infection.
CONCLUSIONS: PMA after elective open abdominal aortic aneurysm surgery is proven to be an effective measure to reduce IH formation and should be considered in future guidelines as standard of care.
Disciplines :
Surgery
Author, co-author :
van den Berg, Rudolf ; Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
Den Hartog, Floris P J; Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
Baart, Sara J; Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, Netherlands
Bali, Christina; Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
Matsagkas, Miltiadis; Department of Vascular Surgery, University of Thessaly, Larissa, Greece
Bevis, Paul M; Department of Vascular Surgery, North Bristol NHS Trust, United Kingdom
Earnshaw, Jonothan J; Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, UK
Debus, Eike S; Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Eppendorf, Hamburg, Germany
Honig, Susanne; Department of Vascular Surgery, Hospital Robert Schuman Kirchberg Hospital, Luxembourg
Berrevoet, Frederik; Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
Detry, Olivier ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne
Stabilini, Cesare; Department of Surgical Sciences, University of Genoa, Genoa, Italy
Muysoms, Filip E; Department of Surgery, AZ Maria Middelares Hospital, Ghent, Belgium
Tanis, Pieter J; Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
European Hernia Society Prophylactic mesh study group collaborators
A Systematic Review and Independent Patient Data Meta-Analysis of Prophylactic Mesh Augmentation for Incisional Hernia Prevention after Abdominal Aortic Aneurysm Surgery (I-PREVENT-AAA) A Collaborative European Hernia Society Project.
Publication date :
26 January 2026
Journal title :
Annals of Surgery
ISSN :
0003-4932
eISSN :
1528-1140
Publisher :
Ovid Technologies (Wolters Kluwer Health), United States
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