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Abdominal wall closure with prophylactic mesh in colorectal operations
Author(s) -
Wong Jean,
Jones Julia,
Ananthapadmanabhan Saikrishna,
Meagher Alan P.
Publication year - 2020
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15692
Subject(s) - medicine , seroma , laparotomy , surgery , ileostomy , colorectal surgery , surgical mesh , fibrous joint , general surgery , abdominal surgery , complication , hernia
Background Prospective studies demonstrate that over one‐third of patients undergoing standard suture closure of laparotomy wounds will develop incisional hernias (IHs). Whilst prophylactic mesh has been demonstrated to decrease IH rates in clean laparotomy wounds, mesh has been associated with high rates of seroma formation (>30%), infection (>10%) and pain, discouraging many surgeons from using mesh, especially combined with intestinal surgery. The aim of this study is to review the experience of a single colorectal surgeon who, after noting high IH rates in his own patients, started placing prophylactic mesh routinely in patients judged to be at high risk of IH. Methods The records of all patients undergoing bowel resections and ileostomy closure by one surgeon from 2008 to 2018 were independently retrospectively analysed. Results Of the 935 procedures identified, 662 patients underwent midline laparotomy with bowel resection and 273 patients underwent closure of loop ileostomy. Mesh was placed prophylactically in 221 (23.6%) of 935 procedures. Comparing the mesh and non‐mesh groups, wound infections occurred in nine (4.1%) versus 23 (3.2%) ( P = 0.53), seromas occurred in nine (4.1%) versus six (0.8%) ( P = 0.003) and chronic pain was noted in 12 (5.4%) versus 17 (2.4%) ( P = 0.04). The mean follow‐up was 33 months in both the mesh and non‐mesh groups. IHs have occurred in three (1.3%) of the mesh group compared to 95 (13.3%) of the non‐mesh group procedures ( P = 0.0001). Conclusion In colorectal operations, prophylactic mesh decreases the risk of IH without prohibitive complications.