SP9.6 Effectiveness and safety of prophylactic mesh closure in emergency Gastrointestinal surgery

Abstract

Abstract Background Wound complications are frequent in emergency Gastro-Intestinal (GI) surgery increasing morbidity and cost of care. Although laparotomy closure using a prophylactic mesh has been proven to limit Incisional Hernia (IH) occurrence, the literature lacked a high-quality assessment in the setting of emergency GI laparotomy. This review offers an up-to-date evaluation of the prophylactic mesh closure in these conditions. Methods A systematic review was executed via literature database: PubMed, Cochrane database, Science Direct and Google Scholar. Studies were examined for eligibility and included if they managed to compare prophylactic mesh closure to the conventional laparotomy closure in GI emergency surgeries. Both early postoperative fascial dehiscence and late incisional hernia were examined as primary endpoints. Secondary outcomes incorporate Surgical Site Infection (SSI), seroma/hematoma formation, complications of Clavien-Dindo score ≥3, operative time, and hospital stay. Results 2 Randomised controlled trials (RCTs)(1, 2) and 2 comparative studies,(3, 4) which studied 562 patients, met the inclusion criteria. The hernia rate was significantly reduced in the mesh group (Odds Ratio 0.14 [0.05, 0.36], P value < 0.0001), while there was no statistically significant difference in fascial dehiscence between the studied groups (Odds Ratio 0.49 [0.01, 47.02], P value= 0.76). In addition, there was no significant outcome favouring one group over the other in terms of SSI and rest of the screened endpoints. Conclusion Despite the promising reduction in IH rate, a solid outcome was not obtained due to the limited number of relevant studies, paucity of RCTs and diversity in surgical techniques and mesh positions. A wider-scale RCTs may offer reliable results.