Comparative study of prophylactic mesh repair versus primary suture repair to decrease incidence of incisional hernia after Midline elective open laparotomy

Abstract

Introduction- Incisional hernia repair have high recurrence rates. Patients suffering from IH experience deterioration in quality of life and long-term dysfunction. Prevention of incisional hernias is essential for addressing the considerable associated morbidity and cost. The present study was conducted to compare the incidence of incisional hernia in patients with prophylactic mesh placement and those undergoing primary suture repair after 15 months of follow up and to assess postoperative complications among them. Material and methods- The present comparative follow up study was conducted at the department of Surgery of a medical college hospital. A total of 34 patients above 18 years of age undergoing elective midline laparotomy had mesh placement and another 34 patients were randomly selected who had primary closure of the abdominal wound. Socio-demographic profile of patients, their medical history, details of surgery and postoperative complications at 1, 6, 12 and 15 months were noted. Results- The incidence of incisional hernia for 15 months follow-up was 26.5 cases per 100 surgeries with primary closure while incidence was found to be 5.8 in those with prophylactic mesh. At 15 months, 11.8% of those with primary closure had pain, 5.9% had enterocolic fistula and 26.5% had incisional hernia. 11.8% of those with mesh placement had pain, 2.9% had enterocolic fistula and 5.9% had incisional hernia. The post-operative complications were not significant statistically for both study groups. Conclusion- Relative risk of incisional hernia in those with primary closure as compared to mesh placement was found to be 4.5 (95% CI- 1.1-19.3).