Peer-reviewed veterinary case report
Preventing hernias after emergency belly surgery with mesh or stitches
By Mäkäräinen E et al.·2025·Oulu University Hospital·View original on Europe PMC →
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Original publication title: Prophylactic Retrorectus Mesh Versus Small-Stitch Closure After Emergency Midline Laparotomy: 2-Year Results of a Randomized Controlled Trial.
Plain-English summary
This study looked at whether using a special mesh to reinforce the abdominal wall could help prevent incisional hernias (bulges that can occur after surgery) in patients who had emergency surgery on their abdomen. Researchers compared this mesh method to a standard stitching technique in a group of patients. Out of 109 patients who started the study, 72 received one of the two treatments. After two years, only one patient in the standard stitch group developed an incisional hernia, while none in the mesh group did, but some patients with the mesh had complications related to it. Overall, the mesh did not significantly reduce the number of hernias compared to the standard method, and the study couldn't draw strong conclusions due to having fewer patients than planned.
Abstract
<h4>Introduction</h4>Incisional hernias (IH) are common complications following emergency midline laparotomies. Mesh reinforcement has shown efficacy in preventing incisional hernias in elective surgeries, but evidence remains limited for emergency midline incisions. This study aimed to evaluate the safety and effectiveness of retrorectus placement of a self-gripping polyester mesh in preventing incisional hernia after emergency midline laparotomy, as measured by the incidence of IH, postoperative complications, quality of life, and health economic outcomes.<h4>Methods</h4>In this multicenter randomized controlled trial, adult patients undergoing emergency midline laparotomy were randomized to receive either prophylactic retrorectus mesh or standard 4:1 small-stitch fascial closure using a slowly absorbable monofilament suture. The primary outcome was the radiological/clinical IH rate within 2 years after the surgery. Secondary outcomes were complications, reoperations, quality of life, and health-economic measures. Blinding was maintained for patients, outcome assessors, and radiologists. Due to difficulties in recruitment, the study was prematurely terminated prior to reaching the aimed number of patients.<h4>Results</h4>Out of 925 patients screened, 109 were randomized, and 72 received the allocated intervention. At 2-year's follow-up, one (4%) asymptomatic incisional hernia was detected in the control group compared to none in mesh group. In the mesh group, three (9%) patients experienced mesh-related complications: one (5%) retrorectus hematoma, one (5%) internal hernia and one (5%) postoperative seroma. One (5%) additional patient in the mesh group developed a fistula requiring mesh removal. No significant differences were found in early postoperative complications or quality of life between groups.<h4>Conclusion</h4>Retrorectus mesh reinforcement did not reduce the incidence of incisional hernia compared to standard small-stitch closure in this trial. However, mesh-related complications were observed. Due to recruitment challenges and limited sample size, definitive conclusions cannot be drawn.<h4>Clinical trial registration</h4>https://clinicaltrials.gov/study/NCT04311788?term=preemer&rank=1, NCT04311788.
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Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41394095