Abstract
BackgroundIncisional hernia (IH) is a common, late complication of open repair of an abdominal aortic aneurysm (AAA), with a variable high incidence. A cohort study was conducted to investigate the role of a lightweight titanized mesh placed in the pre-peritoneal space after AAA repair. The primary endpoint was to determine the incidence of IH at eight weeks and 12 months.MethodsConsecutive patients who underwent open repair of AAA with the prophylactic implantation of a mesh after abdominal wall closure were recruited. The development of IH was evaluated using clinical examination, ultrasonography scan (USS), and computed tomography (CT) scan during the follow-up period.ResultsThirty-nine of 45 patients (34 male, 5 female, mean age 69.6 +/- 6.5 years) undergoing open repair of AAA over a five-year period via a preferred roof-top incision were analyzed for this study. One additional (2.5%) patient had the mesh explanted following a re-laparotomy for colonic ischemia and later developed an incisional hernia. There was no incidence of wound or mesh infection overall. One radiologically detected early IH closed spontaneously. There were five (12.8%) radiologically detected late cases of midline or paramedian defects beyond the one-year follow-up though this was not clinically significant; compared to this, there was no incidence of lateral defects in the wound (p<0.01, McNemar’s test).ConclusionThese preliminary results suggest that a dedicated lightweight titanized mesh is usable for primary reinforcement of rooftop incisions at the time of wound closure. Whilst this study supports the role of a mesh as a useful adjunct, larger studies and long-term follow-up would provide more sensitive assessments of its efficacy.
Highlights
Incisional hernia (IH) is an often-underestimated complication following open abdominal aortic aneurysm (AAA repair) with rates as high as 35% or more [1,2,3]
High recurrence rates have been reported from suture repair only for incisional hernias [1,2,3,4,5,6,7,8,9]; the use of a prophylactic primary mesh for abdominal wall closure following the open repair of AAA remains promising in the reduction of postoperative IH [2,4,10,11,12]
We report our local experience with the use of prophylactic implantation of titanium mesh incorporated at the time of closure of rooftop incisions used for open AAA repair
Summary
Incisional hernia (IH) is an often-underestimated complication following open abdominal aortic aneurysm (AAA repair) with rates as high as 35% or more [1,2,3]. Studies have shown that the risk of IH can be reduced [2] with meticulous surgical wound closure techniques following laparotomies for major abdominal operations [5]. It does not completely hold true for patients undergoing repair of AAA, perhaps due to their underlying inherent genetic disorder [6]. Incisional hernia (IH) is a common, late complication of open repair of an abdominal aortic aneurysm (AAA), with a variable high incidence. The primary endpoint was to determine the incidence of IH at eight weeks and 12 months
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