title: Prophylactic mesh to prevent incisional hernia: a note of caution.
abstract: BACKGROUND
  Ventral hernia is a common complication of open Roux-en-Y gastric bypass (RYGB). The aim of this study was to determine whether prophylactic mesh placement during RYGB would reduce the incidence of postoperative hernias.
  
  
  METHODS
  Obese patients undergoing RYGB by a single surgeon had prosthetic mesh placed in a subfascial location at the conclusion of the procedure. The incidences of recurrent hernia and morbidity associated with the placement of mesh were assessed.
  
  
  RESULTS
  Sixteen patients underwent RYGB with prophylactic mesh placement over 6 months. The average preoperative body mass index was 46.6 kg/m(2). Half of the patients were diabetics. None were smokers. During mean follow-up of 6 months, 4 patients (25%) required mesh excision, 3 for infection and 1 for a persistently symptomatic seroma. One patient was explanted incidentally in the course of reexploration for intractable nausea and vomiting. Another developed an incisional hernia despite prophylactic mesh.
  
  
  CONCLUSIONS
  In the investigators' experience, the use of prophylactic new-generation mesh at the time of open RYGB led to an unacceptable rate of local complications. They caution against this technique in patients undergoing open RYGB.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Ft Lewis, WA, USA. garth_herbert@hotmail.com
authors.forename: Garth S
authors.initials: GS
authors.lastname: Herbert
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tausch
authors.forename: Preston L
authors.initials: PL
authors.lastname: Carter
mesh_terms: D015992:Body Mass Index; D015390:Gastric Bypass / Q000009:adverse effects*; D006555:Hernia, Ventral / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012008:Recurrence; D013526:Surgical Mesh