title: Prevention of Incisional Hernias by Prophylactic Mesh-augmented Reinforcement of Midline Laparotomies for Abdominal Aortic Aneurysm Treatment: A Randomized Controlled Trial.
abstract: BACKGROUND
  The incidence of incisional hernias after abdominal aortic aneurysm repair is high. Prophylactic mesh-augmented reinforcement during laparotomy closure has been proposed in patients at high risk of incisional hernia.
  
  
  METHODS
  A multicenter randomized trial was conducted on patients undergoing elective abdominal aortic aneurysm repair through a midline laparotomy (Clinical.Trials.gov: NCT00757133). In the study group, retromuscular mesh-augmented reinforcement was performed with a large-pore polypropylene mesh (Ultrapro, width 7.5 cm). The primary endpoint was the incidence of incisional hernias at 2-year follow-up.
  
  
  RESULTS
  Between February 2009 and January 2013, 120 patients were recruited at 8 Belgian centers. Patients' characteristics at baseline were similar between groups. Operative and postoperative characteristics showed no difference in morbidity or mortality. The cumulative incidence of incisional hernias at 2-year follow-up after conventional closure was 28% (95% confidence interval [CI], 17%-41%) versus 0% (95% CI, 0%-6%) after mesh-augmented reinforcement (P < 0.0001; Fisher exact test). The estimated "freedom of incisional hernia" curves (Kaplan-Meier estimate) were significantly different across study arms (χ = 19.5, P < 0.0001; Mantel-Cox test). No adverse effect related to mesh-augmented reinforcement was observed, apart from an increased mean time to close the abdominal wall for mesh-augmented reinforcement compared with the control group: 46 minutes (SD, 18.6) versus 30 minutes (SD, 18.5), respectively (P < 0.001; Mann-Whitney U test).
  
  
  CONCLUSIONS
  Prophylactic retromuscular mesh-augmented reinforcement of a midline laparotomy in patients with abdominal aortic aneurysm is safe and effectively prevents the development of incisional hernia during 2 years, with an additional mean operative time of 16 minutes.
authors.affiliation: *Department of Surgery, AZ Maria Middelares Hospital, Ghent, Belgium†Department of Surgery, CHU Liege, University de Liege, Liege, Belgium‡Department of Surgery, ASZ Hospital, Aalst, Belgium§Department of Surgery, Sint Augustinus Hospital, Antwerpen, Belgium¶Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium||Department of Surgery, University Hospital Antwerpen, Edegem, Belgium**Department of Surgery, Imelda Hospital Bonheiden, Bonheiden, Belgium††Department of Vascular Surgery, CHU Liege, University de Liege, Liege, Belgium‡‡Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium.
authors.forename: Filip E
authors.initials: FE
authors.lastname: Muysoms
authors.forename: Olivier
authors.initials: O
authors.lastname: Detry
authors.forename: Tijl
authors.initials: T
authors.lastname: Vierendeels
authors.forename: Marc
authors.initials: M
authors.lastname: Huyghe
authors.forename: Marc
authors.initials: M
authors.lastname: Miserez
authors.forename: Martin
authors.initials: M
authors.lastname: Ruppert
authors.forename: Tim
authors.initials: T
authors.lastname: Tollens
authors.forename: Jean-Olivier
authors.initials: JO
authors.lastname: Defraigne
authors.forename: Frederik
authors.initials: F
authors.lastname: Berrevoet
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000295:instrumentation; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D000069290:Incisional Hernia / Q000453:epidemiology / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome