Long-term follow-up of prophylactic mesh reinforcement after emergency laparotomy. A retrospective controlled study

A Bravo-Salva, N Argudo-Aguirre, A M González-Castillo, E Membrilla-Fernandez, J J Sancho-Insenser, L Grande-Posa, M Pera-Román, J A Pereira-Rodríguez, A Bravo-Salva, N Argudo-Aguirre, A M González-Castillo, E Membrilla-Fernandez, J J Sancho-Insenser, L Grande-Posa, M Pera-Román, J A Pereira-Rodríguez

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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. www.clinicaltrials.gov.

Keywords: Contaminated surgery and long-term follow up; Emergency Surgery; Hernia prevention; Prophylactic mesh.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Study’s flow chart
Fig. 2
Fig. 2
General free hernia COX survival curve

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