Caro-Tarrago A, Olona C, Millán M, Olona M, Espina B, Jorba R
General and Digestive Surgery Service, Department of Surgery, University Hospital Joan XXIII, 43007, Tarragona, Spain.
Department of epidemiology and Preventive Medicine, University Hospital Joan XXIII, Tarragona, Spain.
Hernia. 2019 Apr;23(2):335-340. doi: 10.1007/s10029-019-01891-2. Epub 2019 Jan 30.
Incisional hernia (IH) continues to be one of the most common complications of laparotomy. The short-term protective effect of the use of mesh has been demonstrated in several studies. At present, there is little evidence on the long-term results of the prophylactic use of mesh. The aim of the present study is to analyze the long-term prevention of IH 5 years after a midline laparotomy during elective surgery.
A prospective study was performed including all of the 160 patients that had been previously included in the prospective, randomized, controlled trial performed between May 2009 and November 2012. The protocol and results at 1 year have been previously published in 2014. The patients in group A (mesh) were fitted with a polypropylene mesh to reinforce the standard abdominal wall closure. The patients in group B (non-mesh) underwent a standard abdominal wall closure and were not fitted with the mesh. All patients were followed for 5 years or until the diagnosis of incisional hernia was made, further surgery was performed, or the patient died. Cases lost to follow-up were also registered.
Five years after surgery, in group A (mesh) we have found 4/80 (5.1%) incisional hernias, while in group B (no mesh) 37/80 patients were diagnosed with an incisional hernia (46.8%). The Kaplan-Meier survival curves for these results show statistically significant differences (p > 0.001).
The protective effect of the use of an onlay mesh in abdominal wall closure is significantly maintained in the long-term, up to 5 years after surgery. International Standard Randomized Controlled Trial number: ISRCTN98336745.
切口疝（IH）仍然是剖腹手术最常见的并发症之一。多项研究已证实使用补片具有短期保护作用。目前，关于预防性使用补片的长期效果的证据较少。本研究的目的是分析择期手术中行正中剖腹手术后5年切口疝的长期预防情况。
进行了一项前瞻性研究，纳入了2009年5月至2012年11月期间进行的前瞻性、随机、对照试验中的所有160例患者。1年时的方案和结果已于2014年发表。A组（补片组）患者使用聚丙烯补片加强标准腹壁缝合。B组（无补片组）患者进行标准腹壁缝合，未使用补片。所有患者随访5年，或直至诊断为切口疝、进行进一步手术或患者死亡。失访病例也进行了记录。
术后5年，A组（补片组）发现4/80（5.1%）例切口疝，而B组（无补片组）有37/80例患者被诊断为切口疝（46.8%）。这些结果的Kaplan-Meier生存曲线显示出统计学上的显著差异（p＞0.001）。
腹壁缝合中使用覆盖补片的保护作用在长期内显著维持，直至术后5年。国际标准随机对照试验编号：ISRCTN98336745。
