FROM ANNALS OF SURGERY
The use of a large-pore polypropylene mesh in colorectal surgery can reduce incidence of incisional hernias without contributing to wound complication risk, according to results from a randomized controlled trial.
While prophylactic polypropylene meshes have been used successfully in other types of surgeries to prevent hernias, they have been little studied in series of patients undergoing colorectal surgeries, a group for which incidence of IH is high, and particularly so with emergency procedures.
For their research , published ahead of print in Annals of Surgery (Ann. Surg.2015 Jan 8 [doi: 10.1097/SLA.0000000000001116]), Dr. Miguel Ángel García-Ureña of Henares University Hospital in Madrid, and his colleagues, recruited 107 patients with elective or emergency colorectal surgeries using a midline laparotomy approach.
Patients were randomized to either standard care (n = 54, 20 emergency) or the addition of an overlay large-pore polypropylene mesh after the closure of the abdominal wall (n = 53, 17 emergency). All operations took place at the same hospital, with 12 surgeons participating.
At 24 months’ follow-up, the control group saw 17 incisional hernias (31.5%), compared with 6 (11.3%) in the study group (P = .011). No statistically significant differences were seen for incidence of surgical site infection, seroma, evisceration, or systemic complications, and no mesh rejection was seen.
Dr. García-Ureña and colleagues used a very low-weight, large-pore polypropylene mesh after initial studies suggested large-pore meshes were better tolerated in contaminated fields, and that these could be salvaged even in the case of site infection.
The study “confirms the safe use of large-pore polypropylene meshes even in contaminated and emergency surgical procedures,” the investigators wrote in their analysis, adding that the use of mesh overlay “was cost-effective due to the number needed to treat obtained: 1 IH was prevented for every 5 prophylactic meshes that were used.”
Dr. García-Ureña and colleagues cited as limitations of their study the fact that deaths and reoperations occurred in 28% of patients before follow-up ended, the inclusion of both elective and emergency cases, and that wound length was not recorded. Further studies will be needed, they said, to determine the ideal positioning of the mesh and the best type of mesh for these procedures.
The study authors declared no conflicts of interest.