Is it time for a better emergent laparotomy sunset? Prophylactic sub-lay non absorbable mesh following emergent midline laparotomy in clean and clean/contemned field: early results of a randomized double blind prospective trial.

Methods

The study is a double-blind randomized trial comparing simple double-layer laparotomy closure with permanent sub-lay mesh reinforced suture. From Gennuary 2017 to June 2018, 100 Patients undergoing median laparotomy for emergency clean and clean-contaminated surgery where included and divided in two groups: primary closure (Group A) and sublay mesh supported closure (Group B). Primary endpoint was the IH rate at 1-year follow-up.

Secondary endpoints were feasibility and safety of mesh stripe implantation (including postoperative pain) and morbidity/mortality rate in the two groups. Results: A total of 100 patients were included in this study. Follow-up at 1 year was available for 93 patients (Group A =47; Group B =45).

IH was diagnosed in 11/46 (23%) patients of Group A and in 2/45 (4%) patients of Group B (p<0.01). In both groups, minor and major complications as well as postoperative pain are reported with no statistically significant difference between the two groups. Conclusion: Prophylactic strip mesh [Progrip Parietex (Medtronic)] abdominal wall reinforcement in retro-muscular position at the time of emergent laparotomy in clean/clean-contaminated wounds is safe.

Its use may be effective to reduce IH rate, although longer term follow-up is required.