S Valverde1, M A Arbós2, M T Quiles2, E Espín2,3, J L Sánchez-Garcia2,3, V Rodrigues1,2, J A Pereira4, R Villalobos5, J M García-Alamino6,7, M Armengol1,2, M López-Cano8,9. 1. Unit of Abdominal Wall Surgery, Service of Digestive and General Surgery, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain. 2. Vall D'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall D'Hebron, Barcelona, Spain. 3. Unit of Colorectal Surgery, Service of General and Digestive Surgery, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 4. Service of General and Digestive Surgery, Department of Health and Experimental Sciences, Hospital del Mar, Universitat Pompeu Fabra, Parc de Salut Mar, Barcelona, Spain. 5. Service of General and Digestive Surgery, Hospital Arnau de Vilanova, Universitat de Lleida, Lleida, Spain. 6. Grupo de Investigación Salud Global, Género Y Sociedad (GHenderS), Blanquerna-Universitat Ramon Llull, Barcelona, Spain. 7. Programme in Evidence Based Health Care, University of Oxford, Oxford, UK. 8. Unit of Abdominal Wall Surgery, Service of Digestive and General Surgery, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain. mlpezcano@gmail.com. 9. Vall D'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall D'Hebron, Barcelona, Spain. mlpezcano@gmail.com.
Abstract
INTRODUCTION: The objective was to assess the effectiveness and safety of a bioabsorbable mesh at the time of closure of a midline laparotomy for IH prevention. MATERIALS AND METHODS: A multicenter, randomized clinical trial including patients undergoing abdominal surgical procedures through a midline laparotomy incision was designed. In the group of mesh (n = 167) the incision was closed using a continuous polydioxanone suture (PDS) plus a bioabsorbable mesh. In the control group (n = 165) a continuous PDS single layer suture was only used. Patients were randomly assigned (1:1) to the two groups. The primary outcome was the incidence of IH at 6, 12 and 24 months. Assessment of IH was done using a CT scan. RESULTS: At 6 months, the rates of IH were 15.2% and 24.8% in the experimental and control groups, respectively (relative risk [RR] 0.66, 95% confidence interval [CI] 0.38-0.98, P = 0.042). At 12 months, the rate of IH continued to be significantly lower in the experimental group (21.4% vs. 33.1%, P = 0.033), but at 24 months, there were no significant differences between the study groups with a follow-up rate of only 37.5%. The number needed to treat (NNT) was 11 and 9 at 6 and 12 months, respectively. CONCLUSION: The bioabsorbable mesh significantly prevented IH during the first year. Not reliable conclusions can be drawn across the second year. This may suggest that the any of the closing technique assessed in this study would have a "palliative" transient effect for preventing IH in the long-term.
INTRODUCTION: The objective was to assess the effectiveness and safety of a bioabsorbable mesh at the time of closure of a midline laparotomy for IH prevention. MATERIALS AND METHODS: A multicenter, randomized clinical trial including patients undergoing abdominal surgical procedures through a midline laparotomy incision was designed. In the group of mesh (n = 167) the incision was closed using a continuous polydioxanone suture (PDS) plus a bioabsorbable mesh. In the control group (n = 165) a continuous PDS single layer suture was only used. Patients were randomly assigned (1:1) to the two groups. The primary outcome was the incidence of IH at 6, 12 and 24 months. Assessment of IH was done using a CT scan. RESULTS: At 6 months, the rates of IH were 15.2% and 24.8% in the experimental and control groups, respectively (relative risk [RR] 0.66, 95% confidence interval [CI] 0.38-0.98, P = 0.042). At 12 months, the rate of IH continued to be significantly lower in the experimental group (21.4% vs. 33.1%, P = 0.033), but at 24 months, there were no significant differences between the study groups with a follow-up rate of only 37.5%. The number needed to treat (NNT) was 11 and 9 at 6 and 12 months, respectively. CONCLUSION: The bioabsorbable mesh significantly prevented IH during the first year. Not reliable conclusions can be drawn across the second year. This may suggest that the any of the closing technique assessed in this study would have a "palliative" transient effect for preventing IH in the long-term.
Authors: Manuel López-Cano; Manel Armengol; Maria Teresa Quiles; Alex Biel; Janice Velasco; Pere Huguet; Aleix Mestre; Lluís María Delgado; Francesc Xavier Gil; Maria Antonia Arbós Journal: J Surg Res Date: 2012-06-01 Impact factor: 2.192
Authors: F E Muysoms; S A Antoniou; K Bury; G Campanelli; J Conze; D Cuccurullo; A C de Beaux; E B Deerenberg; B East; R H Fortelny; J-F Gillion; N A Henriksen; L Israelsson; A Jairam; A Jänes; J Jeekel; M López-Cano; M Miserez; S Morales-Conde; D L Sanders; M P Simons; M Śmietański; L Venclauskas; F Berrevoet Journal: Hernia Date: 2015-01-25 Impact factor: 4.739
Authors: Sandra I Berríos-Torres; Craig A Umscheid; Dale W Bratzler; Brian Leas; Erin C Stone; Rachel R Kelz; Caroline E Reinke; Sherry Morgan; Joseph S Solomkin; John E Mazuski; E Patchen Dellinger; Kamal M F Itani; Elie F Berbari; John Segreti; Javad Parvizi; Joan Blanchard; George Allen; Jan A J W Kluytmans; Rodney Donlan; William P Schecter Journal: JAMA Surg Date: 2017-08-01 Impact factor: 14.766
Authors: David C Bosanquet; James Ansell; Tarig Abdelrahman; Julie Cornish; Rhiannon Harries; Amy Stimpson; Llion Davies; James C D Glasbey; Kathryn A Frewer; Natasha C Frewer; Daphne Russell; Ian Russell; Jared Torkington Journal: PLoS One Date: 2015-09-21 Impact factor: 3.240