Is it time for a better emergent laparotomy sunset? Prophylactic sub-lay non absorbable mesh following emergent midline laparotomy in clean and clean/contemned field: early results of a randomized double blind prospective trial.
Background: Incisional Hernia (IH) is one of the most frequent postoperative complications in abdominal surgery causing significant morbidity and even mortality. This study examines feasibility, safety and IH rate of prophylactic sub-lay mesh stripe implant of Parietex Progrip(Medtronic), in order to prevent IH following midline laparotomy in clean and clean-contaminated wound in an emergency setting. Methods: The study is a double-blind randomized trial comparing simple double-layer laparotomy closure with permanent sub-lay mesh reinforced suture. From Gennuary 2017 to June 2018, 100 Patients undergoing median laparotomy for emergency clean and clean-contaminated surgery where included and divided in two groups: primary closure (Group A) and sublay mesh supported closure (Group B). Primary endpoint was the IH rate at 1-year follow-up. Secondary endpoints were feasibility and safety of mesh stripe implantation (including postoperative pain) and morbidity/mortality rate in the two groups. Results: A total of 100 patients were included in this study. Follow-up at 1 year was available for 93 patients (Group A =47; Group B =45). IH was diagnosed in 11/46 (23%) patients of Group A and in 2/45 (4%) patients of Group B (p<0.01). In both groups, minor and major complications as well as postoperative pain are reported with no statistically significant difference between the two groups. Conclusion: Prophylactic strip mesh [Progrip Parietex (Medtronic)] abdominal wall reinforcement in retro-muscular position at the time of emergent laparotomy in clean/clean-contaminated wounds is safe. Its use may be effective to reduce IH rate, although longer term follow-up is required.