Page 111 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

at high risk for incisional hernias. In this RCT by Caro-Tarrago et al. the mesh augmentation was performed with a light weight polypropylene mesh in the onlay position. A signi cant reduction in incisional hernias at 12 months was observed clinically and with CT scan in favour of prophylactic mesh, 1.5 vs 35.9 % (p < 0.0001). A signi cantly higher number of postoperative seroma was detected in the mesh group, 11.3 vs 28.8 % (p < 0.01). No major complications related to the mesh augmentation were reported.
The details of the six published RCT’s using polypropylene mesh including 506 patients are listed in Table 5(105-110). Using Review Manager 5.2 software a new meta-analysis was performed. The data for this meta-analysis were extracted from the Timmermans et al. meta-analysis and the additional RCT(104, 106). A meta-analysis on the outcomes of incisional hernia, seroma and SSI was performed. The pooled analyses data are shown in a Forrest plot for each outcome in Figure 2. Prophylactic mesh augmentation is e ective in the prevention of incisional hernias (RR 0.17: CI 0.08–0.37). An increased incidence of postoperative seroma is identi ed, but the majority of these are from the single study by Caro-Tarrago et al.(106) where the mesh was placed in an onlay position, with a weight of 45.9 % on the cumulative Risk Ratio for seroma (RR = 1.71; 95 %CI: 1.06–2.76) (Figure 2c).
Although the data are favourable and consistent for prophylactic mesh augmentation, the Guidelines Development Group decided that larger trials are needed to make a strong recommendation to perform prophylactic mesh augmentation for all patients within certain risk groups.
5
EHS guidelines
Statement
Prophylactic mesh augmentation for an elective midline laparotomy in a high- risk patient in order to reduce the risk of incisional hernia is suggested.
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