Hadrien Tranchart1,2, Martin Gaillard3,4, Sarah Bekkhoucha1,2, Carmelisa Dammaro1,2, Naim Schoucair1,2, Panagiotis Lainas1,2, Cosmin Sebastian Voican5,2, Pierre Chague6,2,7, Laurence Rocher6,2,7, Ibrahim Dagher1,2. 1. Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92141, Clamart, France. 2. Paris-Saclay University, 91405, Orsay, France. 3. Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92141, Clamart, France. martin.gaillard@aphp.fr. 4. Paris-Saclay University, 91405, Orsay, France. martin.gaillard@aphp.fr. 5. Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, 92140, Clamart, France. 6. Department of Radiology, Antoine Béclère Hospital, AP-HP, 92140, Clamart, France. 7. BIOMAPS, IR4M, UMR8081, F-91401, Orsay, France.
Abstract
BACKGROUND: SPSG carries a risk of incisional hernia, particularly in patients with high body mass index. Prophylactic mesh placement with either permanent or absorbable mesh could decrease the occurrence of incisional hernia, with uncertainty on other postoperative parietal complications. METHODS: This is a non-randomized monocentric single-blinded prospective study. High-risk patients (body mass index ≥ 45 kg/m2) underwent either 3 strategies of parietal closure (suture with or without permanent or absorbable mesh) during SPSG. The primary outcome was the occurrence of radiologically defined incisional hernia during the first postoperative year. Secondary outcomes included surgical site infection rates and postoperative pain. RESULTS: Between November 2018 and November 2019, 255 patients were included (85 in each group). All patients reached one-year postoperative follow-up. Significantly more incisional hernias were observed in the no mesh group in comparison with permanent and absorbable mesh groups, respectively (20% vs. 7.1% vs. 5.1%, P = 0.005). No difference was observed in mesh groups. No difference was observed regarding other parietal complications. One patient in the absorbable mesh group presented a superficial surgical site infection and required surgical drainage without mesh removal and one patient in the permanent mesh group presented a parietal hematoma and required surgical drainage with mesh removal. Twenty-six (92.8%) asymptomatic patients presented incisional hernia discovered on the one-year CT-scan. CONCLUSIONS: Prophylactic mesh placement during SPSG decreases the occurrence of postoperative incisional hernia. Routine permanent mesh placement could be proposed in high-risk patients.
BACKGROUND: SPSG carries a risk of incisional hernia, particularly in patients with high body mass index. Prophylactic mesh placement with either permanent or absorbable mesh could decrease the occurrence of incisional hernia, with uncertainty on other postoperative parietal complications. METHODS: This is a non-randomized monocentric single-blinded prospective study. High-risk patients (body mass index ≥ 45 kg/m2) underwent either 3 strategies of parietal closure (suture with or without permanent or absorbable mesh) during SPSG. The primary outcome was the occurrence of radiologically defined incisional hernia during the first postoperative year. Secondary outcomes included surgical site infection rates and postoperative pain. RESULTS: Between November 2018 and November 2019, 255 patients were included (85 in each group). All patients reached one-year postoperative follow-up. Significantly more incisional hernias were observed in the no mesh group in comparison with permanent and absorbable mesh groups, respectively (20% vs. 7.1% vs. 5.1%, P = 0.005). No difference was observed in mesh groups. No difference was observed regarding other parietal complications. One patient in the absorbable mesh group presented a superficial surgical site infection and required surgical drainage without mesh removal and one patient in the permanent mesh group presented a parietal hematoma and required surgical drainage with mesh removal. Twenty-six (92.8%) asymptomatic patients presented incisional hernia discovered on the one-year CT-scan. CONCLUSIONS: Prophylactic mesh placement during SPSG decreases the occurrence of postoperative incisional hernia. Routine permanent mesh placement could be proposed in high-risk patients.