Evaluation of the role of prophylactic onlay proline mesh in incisional hernia prevention after emergency midline laparotomy as compared with standard sheath suturing: a comparative study

Introduction
Incisional hernia (IH) is a major and common complication of midline abdominal operations, and the risk is markedly elevated in high-risk patients and emergency procedures. Mesh enforcement has been adopted in elective laparotomies and proved beneficial by many trials; however, much less studies were conducted in emergency situations.
Objectives
To evaluate if the use of prophylactic mesh in emergency midline laparotomies is a safe and efficient intervention in reducing the risk of IH after these operations.
Patients and methods
Seventy-two patients were included in the present study and were randomized in two groups, group PM (38 patients) who had prophylactic mesh for enforcing their incision, while group SO (34 patients) had only classical suturing of the midline sheath. The surgical outcomes were divided into early and late based on the time of occurrence of complications, such as surgical-site infections, surgical wound dehiscence, seroma, and IH.
Results
Both groups had no significant differences regarding demographic data, associated comorbid diseases, causes, and types of the operations. Within the first 30 postoperative days, 24 patients developed surgical-site infection (13 in group PM and nine in group SO), surgical wound dehiscence occurred in 26 patients (14 in group PM and 12 in group SO), but despite the higher prevalence in group PM, the statistical difference was insignificant. Higher rate of seroma formation was reported in the PM group (23.6 vs. 5.8% in the SO group) with value 0.0499; however, IH was markedly reduced in the patients who had prophylactic mesh in their repair (2.6% in the PM group vs. 26.4% in the SO group).
Conclusion
Mesh prophylaxis can be used as an efficient and safe option in reducing the incidence of IH in emergency midline abdominal incisions.