Incisional Hernias after Vascular Surgery for Aortoiliac Aneurysm and Aortoiliac Occlusive Arterial Disease: Has Prophylactic Mesh Changed This Scenario?
Journal
Aorta (Stamford, Conn.)
ISSN: 2325-4637
Titre abrégé: Aorta (Stamford)
Pays: Germany
ID NLM: 101655549
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
medline:
25
8
2023
pubmed:
25
8
2023
entrez:
24
8
2023
Statut:
ppublish
Résumé
Incisional hernia (IH) is an important surgical complication that has several ways of prevention, including modifications in the surgical technique of the initial procedure. Its incidence can reach 69% in high-risk patients and long-term follow-up. Of the risky procedures, open abdominal aortic aneurysmectomy is the one with the highest risk. Ways to reduce this morbid complication were suggested, and prophylactic mesh rises as an important tool to prevent recurrence. A retrospective cohort study review of medical records of patients undergoing vascular surgery for abdominal aortoiliac aneurysm (AAA) or vascular bypass surgery due to aortoiliac occlusive disease. We identified 193 patients treated between 2010 and 2020. We further performed a one-to-nine matching analysis between the use of prophylactic mesh and control groups, based on estimated propensity scores for each patient. Prophylactic mesh group had a 18% lower risk of IH, compared with the control group (relative risk: 0.82; 95% confidence interval [CI] = 0.74-0.93). The difference in IH rates between the groups compared was 2.6% (95% CI: -19.8 to 25.5). From the perspective of the number needed to treat, it would be necessary to use prophylactic mesh in 39 (95% CI: 35-44) patients to avoid one IH in this population. Use of prophylactic mesh in the repair of AAA significantly reduces the incidence of IH in nearly one in five cases. Our data suggest that there is benefit in the use of prophylactic mesh in open aneurysmectomy surgery regarding postoperative IH development.
Sections du résumé
BACKGROUND
BACKGROUND
Incisional hernia (IH) is an important surgical complication that has several ways of prevention, including modifications in the surgical technique of the initial procedure. Its incidence can reach 69% in high-risk patients and long-term follow-up. Of the risky procedures, open abdominal aortic aneurysmectomy is the one with the highest risk. Ways to reduce this morbid complication were suggested, and prophylactic mesh rises as an important tool to prevent recurrence.
METHODS
METHODS
A retrospective cohort study review of medical records of patients undergoing vascular surgery for abdominal aortoiliac aneurysm (AAA) or vascular bypass surgery due to aortoiliac occlusive disease. We identified 193 patients treated between 2010 and 2020. We further performed a one-to-nine matching analysis between the use of prophylactic mesh and control groups, based on estimated propensity scores for each patient.
RESULTS
RESULTS
Prophylactic mesh group had a 18% lower risk of IH, compared with the control group (relative risk: 0.82; 95% confidence interval [CI] = 0.74-0.93). The difference in IH rates between the groups compared was 2.6% (95% CI: -19.8 to 25.5). From the perspective of the number needed to treat, it would be necessary to use prophylactic mesh in 39 (95% CI: 35-44) patients to avoid one IH in this population.
CONCLUSION
CONCLUSIONS
Use of prophylactic mesh in the repair of AAA significantly reduces the incidence of IH in nearly one in five cases. Our data suggest that there is benefit in the use of prophylactic mesh in open aneurysmectomy surgery regarding postoperative IH development.
Identifiants
pubmed: 37619567
doi: 10.1055/s-0043-1771475
pmc: PMC10449565
doi:
Types de publication
Journal Article
Langues
eng
Pagination
107-111Informations de copyright
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Déclaration de conflit d'intérêts
The authors declare no conflict of interest related to this article.
Références
J Vasc Surg. 2003 Jun;37(6):1150-4
pubmed: 12764257
Stat Med. 2014 Mar 30;33(7):1242-58
pubmed: 24122911
Eur J Vasc Endovasc Surg. 2018 Jul;56(1):120-128
pubmed: 29685678
Eur J Vasc Endovasc Surg. 2007 Feb;33(2):177-81
pubmed: 16934501
Angiology. 2012 Feb;63(2):146-9
pubmed: 21602257
BJS Open. 2021 Mar 5;5(2):
pubmed: 33839746
Lancet. 2017 Aug 5;390(10094):567-576
pubmed: 28641875
Vascular. 2012 Oct;20(5):273-7
pubmed: 22983541
Aorta (Stamford). 2021 Feb;9(1):9-20
pubmed: 34082466
Updates Surg. 2022 Jun;74(3):1105-1116
pubmed: 34287760
J Am Coll Surg. 2015 Apr;220(4):405-13
pubmed: 25690673
J Vasc Surg. 2013 Jun;57(6):1524-30, 1530.e1-3
pubmed: 23548175
Br J Surg. 2010 Oct;97(10):1497-502
pubmed: 20603858
PLoS One. 2015 Sep 21;10(9):e0138745
pubmed: 26389785
Br J Surg. 2014 Oct;101(11):1439-47
pubmed: 25123379
Ann Surg. 2016 Apr;263(4):638-45
pubmed: 26943336
Eur J Vasc Endovasc Surg. 2020 Feb;59(2):227-236
pubmed: 31911135
Surgery. 2012 Jun;151(6):882-8
pubmed: 22381694
Turk Gogus Kalp Damar Cerrahisi Derg. 2021 Oct 20;29(4):465-470
pubmed: 35096443
JAMA Surg. 2019 Feb 1;154(2):109-115
pubmed: 30476940
Int J Environ Res Public Health. 2018 Dec 10;15(12):
pubmed: 30544688