Sistema de Salut de Catalunya
[Ciscar A] Department of Surgery, UD de Medicina de la Vall d’Hebron, Universitat Autonoma de Barcelona, Edifici W, Barcelona, Spain. Hospital Universitari Vall d’Hebron, Barcelona, Spain. [Sánchez-Sáez E] Hospital de Sant Boi, Parc Sanitari Sant Joan de Deu, Sant Boi, Spain. [Vila Tura M] Hospital Universitari de Bellvitge, Hospitalet del Llobregat, Spain. [Ruiz de Leon P] Hospital General de Granollers, Granollers, Spain. [ Gomez Pallarès M] Hospital de Calella, Corporació de Salut del Maresme I La Selva, Calella, Spain. [ Troyano Escribano D] Hospital de Calella, Corporació de Salut del Maresme I La Selva, Calella, Spain. [Abadal Prades M] Hospital de Mataró. Department of Radiology. Consorci Sanitari del Maresme, Mataró, Spain. [Mans Muntwyler E] Hospital de Mataró. Department of Surgery. Consorci Sanitari del Maresme, Mataró, Spain. [Pereira JA] Abdominal Wall Unit, Department of General Surgery, Hospital del Mar. Parc de Salut Mar, Barcelona, Spain. Medicine and Life Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain. [Badia JM] Hospital General de Granollers, Granollers, Spain. School of Medicine, Universitat Internacional de Catalunya, Sarrià‑Sant Gervasi, Barcelona, Spain
Hospital General de Granollers
2025-10-10T12:29:33Z
2025-10-10T12:29:33Z
2024-12
Prophylactic mesh; Hernia; Laparoscopic trocar-site
Malla profilàctica; Hèrnia; Lloc de tròcar laparoscòpic
Malla profiláctica; Hernia; Sitio de trocar laparoscópico
Purpose: Trocar site incisional hernia (TSIH) is a common complication of laparoscopic surgery. In the scientific literature there are few descriptions of methods or tools for its prevention. The aim of this report was to assess the effectiveness and safety of a prophylactic measure designed to lower rates of TSIH. Methods: A multicenter randomized double-blinded clinical trial was performed in high-risk patients (diabetes mellitus and/or age ≥ 70 years and/or BMI ≥ 30 kg/m2 and/or extended incision for specimen retrieval) who underwent either elective or emergency laparoscopic cholecystectomy. Patients were assigned to prophylactic onlay polypropylene mesh fixation (intervention) or to standard trocar closure (control). The main aim was to analyze the efficacy of the intervention, taking occurrence of TSIH as the primary outcome. Clinical and radiological follow up lasted at least one year after surgery. Secondary endpoints were technique-related complications (surgical site occurrences). Results: One hundred and forty-three patients were randomized and finally 116 were analyzed (64 in the intervention arm and 52 in the control arm). Groups were homogeneous. Mean [SD] age, 65 [18] years; 86 (60.6%) were women. The cumulative TSIH incidence was lower in the intervention group although the differences did not reach statistical significance, assessed either radiologically (16 [25.4%] vs 17 [31.5%], p = 0.538) or clinically (9 [16.1%] vs 9 [20], p = 0.613). No differences in surgical site infection, hematoma or seroma were detected. Mean follow-up was 670 days (range 223-1294). Conclusion: Our results show that, when properly assessed, the overall TSIH incidence is extremely high. Although polypropylene onlay mesh placement is safe, it does not appear to be effective in reducing the TSIH incidence rate. Radiological evaluation may be more accurate.
This study was funded by Beca per a la Investigació de la Societat Catalana de Cirurgia 2017.
Article
Published version
English
Hèrnia; Laparoscòpia; Cirurgia - Complicacions; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Equipment and Supplies::Surgical Equipment::Surgical Mesh; DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative Complications; DISEASES::Pathological Conditions, Signs and Symptoms::Pathological Conditions, Anatomical::Hernia::Incisional Hernia; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::equipos y suministros::equipo quirúrgico::mallas quirúrgicas; ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::complicaciones posoperatorias; ENFERMEDADES::afecciones patológicas, signos y síntomas::afecciones patológicas anatómicas::hernia::eventración
Springer
Hernia;28(6)
https://doi.org/10.1007/s10029-024-03124-7
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
Articles científics - HG [171]
