PRIMA, non nocere

Abstract

Ventral incisional hernias are common, result in impairments in quality of life, and account for a heavy financial burden. 1 Holihan JL Henchcliffe BE Mo J et al. Is nonoperative management warranted in ventral hernia patients with comorbidities?: a case-matched, prospective, patient-centered study. Ann Surg. 2016; 264: 585-590 Crossref PubMed Scopus (24) Google Scholar , 2 Poulose BK Shelton J Phillips S et al. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2012; 16: 179-183 Crossref PubMed Scopus (575) Google Scholar Estimates suggest that for every 1% reduction in ventral hernia repairs in the USA there would be a US$32 million cost-saving. 2 Poulose BK Shelton J Phillips S et al. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2012; 16: 179-183 Crossref PubMed Scopus (575) Google Scholar Thus, effective prevention of ventral incisional hernias would have a substantial effect on patient-centred outcomes and resource utilisation. Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trialA significant reduction in incidence of incisional hernia was achieved with onlay mesh reinforcement compared with sublay mesh reinforcement and primary suture only. Onlay mesh reinforcement has the potential to become the standard treatment for high-risk patients undergoing midline laparotomy. Full-Text PDF PRIMA, non nocere: a reply from the authorsWe thank John Harvin and Lillian Kao for their Comment1 on our Article.2 Harvin and Kao stated, on the basis of the results of the PRIMA trial, that we cannot conclude that there are no increased short-term risks associated with use of prophylactic mesh. The short-term results were published in Annals of Surgery in 2015,3 and it is true that we did not specifically power our study with the short-term outcomes in mind. Full-Text PDF