Does prophylactic biologic mesh placement protect against the development of incisional hernia in high-risk patients?
Mots clés
Abstrait
BACKGROUND
The purpose of this study was to determine whether the prophylactic use of a biologic prosthesis protects against the development of incisional hernia in a high-risk patient population.
METHODS
A prospective, nonrandomized trial was conducted on 134 patients undergoing open Roux-en-Y gastric bypass by a single surgeon, at two institutions, from January 2005 to November 2007. At Hospital A, all patients (n=59) underwent fascial closure of the abdominal midline wound with the prophylactic placement of a biologic mesh (AlloDerm®) in an in-lay fashion. Patients at Hospital B (n=75) underwent primary abdominal wall closure using #1 PDS in a running fashion. Data collected included patient demographics, abdominal wall closure technique, postoperative wound complications, follow-up period, and incidence of incisional hernia.
RESULTS
During the study period 134 patients (mean age=40.4 years, 80.7% female) underwent open Roux-en-Y gastric bypass (59.7% mesh, 41.5% nonmesh). Twenty-eight patients were excluded from the analysis secondary to a short follow-up period (mesh=13, nonmesh=11) and/or reoperative surgery unrelated to the development of an incisional hernia (mesh=2, nonmesh=2). The mean follow-up period was 17.3±8.5 months. The overall incidence of incisional hernia was 11.3% (95% CI: 5.2-17.45). The incidence of incisional hernia was significantly lower in the mesh group versus the nonmesh group (2.3 vs. 17.7%, P=0.014). In a multivariate logistic regression model that adjusted for age, sex, body mass index, albumin, smoking, diabetes, prior surgery, seroma formation, weight loss, and mesh placement, the development of incisional hernia was found to be associated with smoking (adjusted odds ratio [OR] 8.46, 95% CI: 1.79-40.00, P=0.007) while prophylactic mesh was noted to be protective against hernia development (adjusted OR 0.06, 95% CI: 0.006-0.69, P=0.02).
CONCLUSIONS
The prophylactic use of biologic mesh for abdominal wall closure appears to reduce the incidence of incisional hernia in patients with multiple risk factors for incisional hernia development.
