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Prophylactic Intraperitoneal Onlay Mesh Following Midline Laparotomy—Long-Term Results of a Randomized Controlled Trial

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A Correction to this article was published on 29 March 2019

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Abstract

Objectives

Incisional hernia, a serious complication after laparotomy, is associated with high morbidity and costs. This trial examines the value of prophylactic intraperitoneal onlay mesh to reduce the risk of incisional hernia after a median follow-up time of 5.3 years.

Methods

We conducted a parallel group, open-label, single center, randomized controlled trial (NCT01003067). After midline incision, the participants were either allocated to abdominal wall closure according to Everett with a PDS-loop running suture reinforced by an intraperitoneal composite mesh strip (Group A) or the same procedure without the additional mesh strip (Group B).

Results

A total of 276 patients were randomized (Group A = 131; Group B = 136). Follow-up data after a median of 5.3 years after surgery were available from 183 patients (Group A = 95; Group B = 88). Incisional hernia was diagnosed in 25/95 (26%) patients in Group A and in 46/88 (52%) patients in Group B (risk ratio 0.52; 95% CI 0.36–0.77; p < 0.001). Eighteen patients with asymptomatic incisional hernia went for watchful waiting instead of hernia repair and remained free of symptoms after of a median follow-up of 5.1 years. Between the second- and fifth-year follow-up period, no complication associated with the mesh could be detected.

Conclusion

The use of a composite mesh in intraperitoneal onlay position significantly reduces the risk of incisional hernia during a 5-year follow-up period.

Trial registration number

Ref. NCT01003067 (clinicaltrials.gov).

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Change history

  • 29 March 2019

    In the original version of the article, Philippe M. Glauser’s, Philippe Brosi’s, Benjamin Speich’s, Samuel A. Käser’s, Andres Heigl’s, and Christoph A. Maurer’s first and last names were interchanged. The names are correct as reflected here. The original article has been corrected.

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Acknowledgements

We thank Milena Marti and Julia Gutzwiller for the help to schedule the various follow-ups. Their work was sponsored by the Margarete and Walter Lichtenstein Foundation.

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Author notes

  1. Philippe M. Glauser and Philippe Brosi have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Hospital of Baselland, University of Basel, Liestal, Switzerland

    Philippe M. Glauser, Philippe Brosi, Benjamin Speich, Samuel A. Käser, Andres Heigl, Robert Rosenberg & Christoph A. Maurer

  2. Department of General Surgery, University Hospital Basel, Basel, Switzerland

    Philippe M. Glauser

  3. Department of Visceral and Transplant Surgery, University Hospital Zürich, Zurich, Switzerland

    Philippe Brosi & Samuel A. Käser

  4. University of Basel and University Hospital Basel, Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, Basel, Switzerland

    Benjamin Speich

  5. Professor of Surgery, Former Chairman of Surgical Department of Liestal, Hirslanden Private Clinic Group, Hirslanden Clinic Beau-Site, Schänzlistrasse 1, 3000, Bern, Switzerland

    Christoph A. Maurer

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Correspondence to Christoph A. Maurer.

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Conflict of interest

Philippe M. Glauser, MD, Philippe Brosi, MD, Benjamin Speich, PhD, Samuel A. Käser A., MD, Andres Heigl, MD, Robert Rosenberg, MD, and Christoph A. Maurer, MD have no conflicts of interest or financial ties to disclose.

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The ​original ​version ​of ​this ​article ​was ​revised: In the original version of the article, Philippe M. Glauser’s, Philippe Brosi’s, Benjamin Speich’s, Samuel A. Käser’s, Andres Heigl’s, and Christoph A. Maurer’s first and last names were interchanged.

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Glauser, P.M., Brosi, P., Speich, B. et al. Prophylactic Intraperitoneal Onlay Mesh Following Midline Laparotomy—Long-Term Results of a Randomized Controlled Trial. World J Surg 43, 1669–1675 (2019). https://doi.org/10.1007/s00268-019-04964-6

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