Midline Laparotomy Update

The material and the surgical technique used to close an abdominal wall incision are decisive factors for the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions has the potential of preventing patients from suffering from incisional hernias and for significant savings in healthcare costs.

For these reasons, incisional hernia is a common complication following laparotomy. Research suggests that the use of a prophylactic mesh can reduce its rates in patients at high risk of incisional hernia.

Several randomized clinical trials have been published on the use of prophylactic mesh in patients undergoing aortic aneurysm surgery, obesity surgery stoma creation, colorectal cancer patients, and other high-risk patients. Due to the lack of sufficient data, no recommendations on the type of mesh, the optimal mesh position, or the optimal mesh fixation technique could be made. Although prophylactic mesh-augmented reinforcement has been performed safely in clean-contaminated setting, one concern is the potential short- or long-term damage caused by a permanent mesh. Application of a non-permanent absorbable for prophylactic mesh-augmented reinforcement might therefore hold some benefit if these meshes will be as effective as permanent meshes.

In this lecture, An Jairam gives an update on the closure of the midline laparotomy, providing an interesting review of whether mesh reinforcement should be used and what kind of meshes should be used, based on the results of the latest studies.