title: Prophylactic synthetic mesh can be safely used to close emergency laparotomies, even in peritonitis.
abstract: BACKGROUND
  This study was conducted to determine the efficacy and safety of the use of a partially absorbable large pore synthetic prophylactic mesh in emergent midline laparotomies for the prevention of evisceration and incisional hernia.
  
  
  METHODS
  Retrospective analysis of all patients who underwent an emergency midline laparotomy between January of 2009 and July of 2010 was performed. Patients with complicated ventral hernia repair, postoperative death, and lack of follow-up were excluded.
  
  
  RESULTS
  A total of 266 patients were included. Laparotomies were closed with a running suture of slow-reabsorbable material in 190 patients (Group S), and 50 patients within this group (26.3%) received additional retention sutures. In 76 patients (Group M), an additional partially absorbable lightweight mesh was placed in the Supra-aponeurotic space. Both groups presented similar complication rates (71.1% Group S vs 80.3% Group M, P = .97). There were no differences regarding surgical-site infection rates (17.9% Group S vs 26.3% Group M; P = .13) or postoperative mortality (13.7% Group S vs 18.3% Group M; P = .346). A total of 150 patients completed the follow-up (99 Group S; 51 Group M) at a mean time of 16.7 months. During follow-up, 36 cases of incisional hernia (24%) were diagnosed: 33 (33%) in Group S, whereas there were only three cases (5.9%) in Group M (P = .0001). Mesh removal for chronic infection was not required in any case.
  
  
  CONCLUSIONS
  The use of a partially absorbable, lightweight large pore prophylactic mesh in the closure of emergency midline laparotomies is feasible for the prevention of incisional hernia without adding a substantial rate of morbidity to the procedure, even if high contamination or infections are present.
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitari del Mar, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Argudo
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitari del Mar, Barcelona, Spain; Department de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain. Electronic address: 86664@parcdesalutmar.cat.
authors.forename: José A
authors.initials: JA
authors.lastname: Pereira
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitari del Mar, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Sancho
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitari del Mar, Barcelona, Spain.
authors.forename: Estela
authors.initials: E
authors.lastname: Membrilla
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitari del Mar, Barcelona, Spain.
authors.forename: M José
authors.initials: MJ
authors.lastname: Pons
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitari del Mar, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Grande
mesh_terms: D000328:Adult; D000368:Aged; D004632:Emergency Medical Services; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013526:Surgical Mesh