PROPHYLACTIC MESH-RELATED REOPERATIONS AND MESH-RELATED PROBLEMS DURING RE-LAPAROTOMY: LONG-TERM RESULTS FROM THE PRIMA TRIAL

Abstract Background Prophylactic mesh reinforcement (PMA) has proven to reduce the incidence of incisional hernia, especially in high-risk patients, but the morbidity of long-term mesh-related complications are largely unknown. This study aims to evaluate all reoperations after mesh-reinforcement 14 years since the initiation of the PRIMA-trial. Study design Patients receiving prophylactic onlay or sublay-mesh in the PRIMA-trial between 2009 and 2012 were included on an as-treated basis from participating centers that made reoperation notes available. Main outcomes were the incidences of abdominal wall complications requiring mesh-explantation, mesh-related ileus, and mesh-related problems during laparotomy for other diagnoses. Results Out of 373 patients randomized to PMA, 242 could be included: 127 with onlay and 115 with sublay mesh. Median follow-up was 69 months (IQR 30–199). Thirty-four patients underwent re-operation for any reason during entire follow-up, 22 after onlay (17.3%) and 12 after sublay mesh (10.4%). Reoperation rate for abdominal wall complications that required mesh explantation was 4/127 (3.1%) after onlay and 0% after sublay mesh. Mesh-related ileus occurred in none of the onlay group, and 3/115 (2.6%) in the sublay group. During subsequent laparotomies for other primary diagnoses, adhesions to the meshes were noted in 3/10 (33%) patients in the onlay-group and 1/5 (20%) in the sublay-group, and the mesh was removed in 10/127 (7.9%) and 7/115 (6.1%) patients, respectively. Conclusions In high-risk patients receiving a prophylactic mesh during midline laparotomy closure, low incidences of mesh complications requiring re-operation and mesh-related problems during unrelated subsequent laparotomies were found, both for the onlay and sublay techniques.