OBJECTIVE This study aimed to evaluate all mesh-related problems during reoperations after mesh-reinforcement 15 years after the start of the PRIMA trial. SUMMARY BACKGROUND DATA Prophylactic mesh reinforcement during closure of a midline laparotomy has proven to reduce the incidence of incisional hernia, especially in high-risk patients, but long-term mesh-related morbidity is largely unknown. METHODS Patients receiving a prophylactic onlay or retro-rectus mesh in the PRIMA trial between 2009 and 2012 were included on an as-treated basis from participating centers that made reoperation notes available. Main outcomes were the incidences of complications requiring mesh explantation, mesh-related ileus, and mesh-related problems during laparotomy for other diagnoses. METHODS Out of 373 patients randomized to prophylactic mesh reinforcement, 242 were included: 127 with onlay and 115 patients with retrorectus mesh. Median follow-up is 27 months (IQR 12-78). Thirty-four patients underwent reoperation for any reason during entire follow-up, 22 after onlay (17.3%) and 12 after retrorectus mesh (10.4%). Reoperation rate for complications that required mesh explantation was 4/127 (3.1%) after onlay and 0/115 (0%) after retrorectus mesh. Mesh-related ileus occurred in none of the onlay group, and 3/115 (2.6%) in the retrorectus group. During subsequent laparotomies for other primary diagnoses, adhesions to the mesh were noted in 3/10 patients in the onlay group and 1/5 patients in the retro-rectus group. Overall, the mesh was removed in 10/127 (7.9%) in the onlay group and 7/115 (6.1%) patients in the retro-rectus group. CONCLUSIONS In high-risk patients receiving a prophylactic mesh during midline laparotomy closure, low incidences of mesh-related complications requiring reoperation and mesh-related problems during unrelated subsequent laparotomies were found, for both the onlay and retrorectus techniques.

中文翻译：

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预防性补片相关再手术和随后再次剖腹手术期间补片相关问题：PRIMA 试验的长期结果。


目的 本研究旨在评估 PRIMA 试验开始 15 年后再次手术期间与补片相关的所有补片相关问题。摘要背景数据已证明，中线剖腹手术闭合过程中预防性补片可以降低切口疝的发生率，特别是在高危患者中，但与补片相关的长期发病率在很大程度上尚不清楚。方法 2009 年至 2012 年间，在 PRIMA 试验中接受预防性嵌体或直肌后网片治疗的患者均根据治疗情况纳入参与中心，这些中心提供了再手术记录。主要结果是需要网片外植的并发症、网片相关肠梗阻以及其他诊断剖腹手术期间与网片相关的问题的发生率。方法 在 373 名随机接受预防性网片加固的患者中，纳入了 242 名患者：127 名患者使用高嵌体，115 名患者使用直肠肌后网片。中位随访时间为 27 个月 (IQR 12-78)。整个随访期间，34 名患者因任何原因接受了再次手术，其中 22 名患者在镶嵌后（17.3%），12 名患者在直肠肌后补片后接受再次手术（10.4%）。需要网片移植的并发症的再手术率在覆盖后为 4/127 (3.1%)，在后直肌网片后为 0/115 (0%)。网片相关的肠梗阻在镶嵌组中均未发生，而在直肠后肌组中则为 3/115 (2.6%)。在随后进行其他初步诊断的剖腹手术期间，在覆盖组中 3/10 的患者和后直肌组中 1/5 的患者中发现网片粘连。总体而言，镶嵌组中 10/127 (7.9%) 的患者和后直肌组中 7/115 (6.1%) 的患者中网片被移除。 结论 在中线剖腹手术闭合过程中接受预防性补片的高危患者中，无论是镶嵌技术还是直肠后肌技术，需要再次手术的补片相关并发症以及不相关的后续剖腹手术中补片相关问题的发生率均较低。