Abstract
Background
Open abdominal aortic aneurysm (AAA) repair is followed by a high rate of incisional herniation. The purpose of this study was to evaluate whether this postoperative complication could be avoided by a prophylactic implantation of a biological mesh.
Methods
In a prospective randomized clinical study, patients electively treated by open AAA repair were allocated equally to routine abdominal suture closure or to prophylactic placement of bovine pericardium mesh above the fascia. The study end points were postoperative complications and incidence of incisional hernia at a 3-year follow up.
Results
Forty patients with a mean age of 74.3 (SD ± 5.8) years were studied. All patients had a successful operation and a quite uneventful postoperative course. The mean operative time in the mesh group was longer compared to the control group (p < 0.001). Two patients in the mesh group developed wound seroma postoperatively. Six patients (30 %) in the control group developed incisional hernia comparing to none in the mesh group. Cumulative proportion of freedom from incisional hernia was 100 % for mesh group at 3 years and 74.4 % (SE 9.9 %) for control group at 2 years (p < 0.008). In five patients (83 %), the incisional hernia was diagnosed by the second postoperative year. One patient underwent incisional hernia repair.
Conclusion
The bovine pericardium mesh reinforcement of fascia closure in patients undergoing open AAA repair showed effectiveness and low complication rate in prophylaxis from incisional herniation. It should be considered as an alternative mesh material in selected patients.
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References
Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89:534–545
Franz MG (2008) The Biology of hernia formation. Surg Clin N Am 88(1):1–15
Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B (2000) Abnormal collagen I to III distribution in the skin of patients with incisional hernia. Eur Surg Res 32(1):43–48
Anderson DW, Edwards TK, Ricketts MH, Kuivaniemi H, Tromp G, Stolle CA et al (1996) Multiple defects in type III collagen synthesis are associated with the pathogenesis of abdominal aortic aneurysms. Ann N Y Acad Sci 800:216–228
Liapis CD, Dimitroulis DA, Kakisis JD, Nikolaou AN, Skandalakis P, Daskalopoulos M et al (2004) Incidence of incisional hernias in patients operated on for aneurysm or occlusive disease. Am Surg 70:550–552
Papadimitriou D, Pitoulias G, Papaziogas B, Koutsias S, Vretzakis G, Argiriadou H et al (2002) Incidence of abdominal wall hernias in patients undergoing aortic surgery for aneurysm or occlusive disease. Vasa 31(2):111–114
Adye B, Luna G (1998) Incidence of abdominal wall hernia in aortic surgery. Am J Surg 175(5):400–402
Takagi H, Sugimoto M, Kato T, Matsuno Y, Umemoto T (2007) Postoperative incision hernia in patients with abdominal aortic aneurysm and aortoiliac occlusive disease: a systematic review. Eur J Vasc Endovasc Surg 33:177–181
Israelsson LA (1999) Incisional hernias in patients with aortic aneurysmal disease: the importance of suture technique. Eur J Vasc Endovasc Surg 17(2):133–135
Rogers M, McCarthy R, Earnshaw JJ (2003) Prevention of incisional hernia after aortic aneurysm repair. Eur J Vasc Endovasc Surg 26(5):519–522
Lord RS, Crozier JA, Snell J, Meek AC (1994) Transverse abdominal incisions compared with midline incisions for elective infrarenal aortic reconstruction: predisposition to incisional hernia in patients with increased intraoperative blood loss. J Vasc Surg 20(1):27–33
Bevis PM, Windhaber RA, Lear PA, Poskitt KR, Earnshaw JJ, Mitchell DC (2010) Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. Br J Surg 97(10):1497–1502
O’Hare JL, Ward J, Earnshaw JJ (2007) Late results of mesh wound closure after elective open aortic aneurysm repair. Eur J Vasc Endovasc Surg 33:412–413
den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 16(3):CD006438
Gaertner WB, Bonsack ME, Delaney JP (2007) Experimental evaluation of four biologic prostheses for ventral hernia repair. J Gastrointest Surg 11:1275–1285
Biasi GM, Sternjakob S, Ferrari PM, Mingazzini SA (2002) Nine-year experience of bovine pericardium patch angioplasty during carotid endarterectomy. J Vasc Surg 36:271–277
Matsagas MI, Bali C, Arnaoutoglou E, Papakostas JC, Nassis C, Papadopoulos G et al (2006) Carotid endarterectomy with bovine pericardium patch angioplasty: mid-term results. Ann Vasc Surg 20:614–619
Cavallaro A, Lo Menzo E, Di Vita M, Zanghì A, Cavallaro V, Veroux PF et al (2010) Use of biological meshes for abdominal wall reconstruction in highly contaminated fields. World J Gastroenterol 16(15):1928–1933
Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL et al (2006) ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Circulation 113:463–654
El-Khadrawy OH, Moussa G, Mansour O, Hashish MS (2009) Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients. Hernia 13:267–274
Strzelczyk JM, Szymański D, Nowicki ME, Wilczyński W, Gaszynski T, Czupryniak L (2006) Randomized clinical trial of postoperative hernia prophylaxis in open bariatric surgery. Br J Surg 93(11):1347–1350
Llaguna OH, Avgerinos DV, Nagda P, Elfant D, Leitman IM, Goodman E (2011) Does prophylactic biologic mesh placement protect against the development of incisional hernia in high-risk patients? World J Surg 35(7):1651–1655
Herbert GS, Tausch TJ, Carter PL (2009) Prophylactic mesh to prevent incisional hernia: a note of caution. Am J Surg 197(5):595–598
Dur AH, den Hartog D, Tuinebreijer WE, Kreis RW, Lange JF (2009) Low recurrence rate of a two-layered closure repair for primary and recurrent midline incisional hernia without mesh. Hernia 13(4):421–426
Ansaloni L, Catena F, Coccolini F, Gazzotti F, D’Alessandro L, Pinna AD (2009) Inguinal hernia repair with porcine small intestine submucosa: 3-year follow-up results of a randomized controlled trial of Lichtenstein’s repair with polypropylene mesh versus Surgisis Inguinal Hernia Matrix. Am J Surg 198(3):303–312
Rosen M (2010) Biologic mesh for abdominal wall reconstruction: a critical appraisal. Am Surg 76:1–6
Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP et al (2001) Classification and surgical treatment of incisional hernia. Results of an experts’ meeting. Langenbeck’s Arch Surg 386:65–73
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Bali, C., Papakostas, J., Georgiou, G. et al. A comparative study of sutured versus bovine pericardium mesh abdominal closure after open abdominal aortic aneurysm repair. Hernia 19, 267–271 (2015). https://doi.org/10.1007/s10029-014-1262-4
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DOI: https://doi.org/10.1007/s10029-014-1262-4