O03 SMALL BITES AND PROPHYLACTIC MESH TO PREVENT INCISIONAL HERNIA IN HIGH-RISK PATIENTS. A MESH IS THE MOST POWERFUL TOOL

Abstract

Abstract Aim Small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by guidelines to prevent incisional hernias (IHs) and burst abdomen (BA). Our aim was to implement a protocol combining both and to analyze its outcomes. Material and Methods Prospective data collection of all EMLs for one year. Results were analyzed at one month and during follow-up. The incidence of IH and BA was compared by groups depending on the use of a PM (M Group) or not (S Group), and in subgroups related to the closure technique: SB (Subgroups MSB and SSB) or not (Subgroups MLB and MSB). Results A lower number of BA was diagnosed in the M group (OR 0.0692; CI95% 0.008-0.56; P = 0.01) in 197 operations. 163 patients completed a mean follow-up of 29.23 months, with a lower frequency of IH in M group patients (OR = 0.769; CI 95% 0.65 - 0.91; P < 0.0001). Same differences persisted after a propensity matching score: BA (OR = 0.355; CI 95% 0.255 - 0.494; P < 0.0001) and IH (OR = 0.394; CI 95% 0.24 - 0.61; P < 0.0001). Comparing suturing techniques by subgroups any difference in IH and BA appeared. PM was the main factor related to reduction of IH (HR 11.794; CI 95% 4.29 - 32.39; P < 0.0001). Conclusions A PM is the most powerful tool for prevention both IH and BA after EMLs, regardless of the closure technique in patients at high-risk for IHs.