Prophylactic retro rectus mesh cuts Incisional Hernia rate in midline laparotomy for abdominal aortic aneurysm

A new trial has revealed  that using prophylactic retro rectus mesh reinforcement can effectively reduce the rate of incisional hernias in midline laparotomy cases done for abdominal aortic aneurysms. The trial results were published in the journal Annals of Surgery. 

There is a high incidence of incisional hernias (IHs) after the open repair of an abdominal aortic aneurysm (AAA). Several trials in the past reported successful results with the use of prophylactic mesh to prevent IHs, without causing any complications. So, Maxime Dewulf et al reported the 5-year (60 months) follow-up results of the PRIMAAT trial. 

A prospective, multicenter, open-label, trial was carried out at eight Belgian hospitals. Patients with the planned elective treatment of an AAA through a midline laparotomy were considered eligible. Participants were randomized between prophylactic retro rectus mesh reinforcement (mesh group), and primary closure of their midline laparotomy after open AAA repair (no-mesh group). Ultrasonography or computed tomography was used for the diagnosis of IHs. The study's primary endpoint was the incidence of IHs 24 months after surgery. 

Results of the study: 

• Of the 120 randomized patients, 114 were included in the intention-to-treat analysis.
• Thirty-three patients in the no-mesh group (33/58—56.9%) and 34 patients in the mesh group (34/56—60.7%) were evaluated after 5 years.
• Between the 24-month and 60-month follow-ups, there was a death of 10 patients in each group. 
• The no-mesh group showed a cumulative incidence of 32.9% IHs after 24 months and 49.2% IHs after 60 months whereas the mesh group did not show any IHs. 
• In the no-mesh group, 21.7% (5/23) underwent reoperation within 5 years due to an IH.

Thus, the long-term results showed that the use of PMR after open AAA repair significantly decreases the IH incidence during the first 5 years after surgery. A cumulative incidence of IHs in no-mesh AAA repair subsequently increased the rate of hernia repairs. 

Further reading: Dewulf M, Muysoms F, Vierendeels T, et al. Prevention of Incisional Hernias by Prophylactic Mesh-augmented Reinforcement of Midline Laparotomies for Abdominal Aortic Aneurysm Treatment: Five-year Follow-up of a Randomized Controlled Trial. Ann Surg. 2022;276(4):e217-e222. doi:10.1097/SLA.0000000000005545