Incisional Hernia Clinical Trial
Official title:
Non Absorbable Mesh Reinforcement of Midline Incision Closure in High Risk Patients, Onlay Versus Preperitoneal Position, a Comparative Clinical Trial
comparison between onlay and preperitoneal augmentation of mid line closure in high risk patients
This study is a randomized comparative clinical trial, carried out in the period from July
2016 to August, 2019, on 47 high-risk patients who are liable to develop incisional hernia,
after elective abdominal operations through midline incisions.
High-risk patients means patients who had one or more of the factors that make them more
liable to develop incisional hernia, as Obesity, Diabetes mellitus (DM), Steroid therapy,
Liver diseases, Renal diseases, Cardiac diseases, Chest diseases , Malignancy, Nutritional
deficiency and Old age.
Institutional Review Board, the ethical committee approved the study, determined the number
of the study patients, all patients were informed and consented.
Randomization was carried out by assistant nurse using randomization computer program.
The patients were randomly divided into two groups:
- Group I: wound closure is reinforced by onlay polypropylene mesh (24 patients)
- Group II: wound closure is reinforced by preperitoneal polypropylene mesh (23 patients).
In both groups midline laparotomy was closed by non-absorbable continuous suture, 4\1 ratio
reinforced with interrupted sutures every 4 bites.
All patients were subjected to: full history taking and clinical examination, radiological
and laboratory investigations and endoscopy if needed.
SURGICAL TECHNIQUE In group I patients, after completion of the deemed surgery, the linea
alba was closed as mentioned before, then the subcutaneous tissue was dissected of the
anterior rectus sheath for 2 cm on both sides, then a polypropylene mesh strip 4 cm width and
4 cm longer than the wound length was applied and centered over the wound, fixed in the onlay
position using prolene sutures 2\0. Suction drain is left in position, subcutaneous tissue
and skin closed as per usual.
In group II patients, a preperitoneal pocket is created at the time of opening the mid line
figure, linea alba is incised separately from peritoneum to facilitate formation of
preperitoneal pocket , at time of closure, the mesh was inserted in the preperitoneal space
after peritoneal closure with Vicryl 3\0 sutures, the mesh is fixed to the peritoneum by 4
stitches in the 4 quadrants , and to linea alba during midline closure , suction drain was
left in the preperitoneal space.
Follow up Patients were followed up in outpatient clinic, (weekly for the first month then
monthly for the first six months and lastly every 3 months for one year( in each visit they
were carefully examined for any wound occurrences or hernia development, superficial probe
ultrasonic examination of abdominal wall was done after 1 week and after 1 month. Demographic
data, preoperative, operative and follow up data was collected tabulated and analyzed using
SPSS 22 program package.
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