Tags

Type your tag names separated by a space and hit enter

Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial.
J Am Coll Surg. 2014 May; 218(5):960-8.JA

Abstract

BACKGROUND

Prosthetic repair has become the standard method for hernia repair. Mesh placement for the prevention of trocar site incisional hernia (TSIH) is still a controversial issue. We tested the hypothesis that closure with an intraperitoneal prophylactic mesh of the umbilical trocar after a laparoscopic cholecystectomy can reduce the incidence of a TSIH in high-risk patients.

STUDY DESIGN

A randomized clinical trial was conducted among patients undergoing elective laparoscopic cholecystectomy who presented the following high-risk factors for incisional hernia, according to the literature: age 65 years and older, diabetes mellitus, chronic pulmonary disease, and obesity (ie, body mass index ≥30 kg/m(2)). Patients were assigned to have closure of the umbilical trocar site with either nonabsorbable sutures (group A) or intraperitoneal polypropylene omega-3 mesh (group B). Trocar site incisional hernia, pain, and surgical complications were evaluated at the early postoperative course and at 1, 6, and 12 months after surgery.

RESULTS

A total of 106 patients were randomized into the study and 92 patients were finally analyzed, including 47 in group A and 45 in group B. The TSIH rate was higher in group A (31.9%) than in group B (4.4%) (odds ratio = 10.1; 95% CI, 2.15-47.6; p < 0.001)). The wound infection rate was 4.3%; 8.5% in group A and 0% in group B (odds ratio = 2.04; 95% CI, 1.7-2.5; p = 0.045). Median postoperative pain evaluated by a visual analogue scale was 3 in group A and 2 in group B (p = 0.05). No differences were observed in complication rate, operative time, or hospital stay between the groups.

CONCLUSIONS

Prosthetic closure of the umbilical trocar site after laparoscopic surgery could become the standard method for preventing TSIH in high-risk patients.

Authors+Show Affiliations

Department of Surgery, General University Hospital Elche, Elche, Spain. Electronic address: laura.armananzas@gmail.com.Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.Department of Surgery, General University Hospital Elche, Elche, Spain.Department of Surgery, Doctor Peset Hospital, Valencia, Spain.Department of Surgery, General University Hospital Elche, Elche, Spain.Department of Surgery, General University Hospital Elche, Elche, Spain.Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

24680572

Citation

Armañanzas, Laura, et al. "Prophylactic Mesh Vs Suture in the Closure of the Umbilical Trocar Site After Laparoscopic Cholecystectomy in High-risk Patients for Incisional Hernia. a Randomized Clinical Trial." Journal of the American College of Surgeons, vol. 218, no. 5, 2014, pp. 960-8.
Armañanzas L, Ruiz-Tovar J, Arroyo A, et al. Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. J Am Coll Surg. 2014;218(5):960-8.
Armañanzas, L., Ruiz-Tovar, J., Arroyo, A., García-Peche, P., Armañanzas, E., Diez, M., Galindo, I., & Calpena, R. (2014). Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. Journal of the American College of Surgeons, 218(5), 960-8. https://doi.org/10.1016/j.jamcollsurg.2014.01.049
Armañanzas L, et al. Prophylactic Mesh Vs Suture in the Closure of the Umbilical Trocar Site After Laparoscopic Cholecystectomy in High-risk Patients for Incisional Hernia. a Randomized Clinical Trial. J Am Coll Surg. 2014;218(5):960-8. PubMed PMID: 24680572.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. AU - Armañanzas,Laura, AU - Ruiz-Tovar,Jaime, AU - Arroyo,Antonio, AU - García-Peche,Pedro, AU - Armañanzas,Ernesto, AU - Diez,María, AU - Galindo,Isabel, AU - Calpena,Rafael, Y1 - 2014/02/18/ PY - 2013/11/01/received PY - 2013/12/23/revised PY - 2014/01/13/accepted PY - 2014/4/1/entrez PY - 2014/4/1/pubmed PY - 2014/6/4/medline SP - 960 EP - 8 JF - Journal of the American College of Surgeons JO - J. Am. Coll. Surg. VL - 218 IS - 5 N2 - BACKGROUND: Prosthetic repair has become the standard method for hernia repair. Mesh placement for the prevention of trocar site incisional hernia (TSIH) is still a controversial issue. We tested the hypothesis that closure with an intraperitoneal prophylactic mesh of the umbilical trocar after a laparoscopic cholecystectomy can reduce the incidence of a TSIH in high-risk patients. STUDY DESIGN: A randomized clinical trial was conducted among patients undergoing elective laparoscopic cholecystectomy who presented the following high-risk factors for incisional hernia, according to the literature: age 65 years and older, diabetes mellitus, chronic pulmonary disease, and obesity (ie, body mass index ≥30 kg/m(2)). Patients were assigned to have closure of the umbilical trocar site with either nonabsorbable sutures (group A) or intraperitoneal polypropylene omega-3 mesh (group B). Trocar site incisional hernia, pain, and surgical complications were evaluated at the early postoperative course and at 1, 6, and 12 months after surgery. RESULTS: A total of 106 patients were randomized into the study and 92 patients were finally analyzed, including 47 in group A and 45 in group B. The TSIH rate was higher in group A (31.9%) than in group B (4.4%) (odds ratio = 10.1; 95% CI, 2.15-47.6; p < 0.001)). The wound infection rate was 4.3%; 8.5% in group A and 0% in group B (odds ratio = 2.04; 95% CI, 1.7-2.5; p = 0.045). Median postoperative pain evaluated by a visual analogue scale was 3 in group A and 2 in group B (p = 0.05). No differences were observed in complication rate, operative time, or hospital stay between the groups. CONCLUSIONS: Prosthetic closure of the umbilical trocar site after laparoscopic surgery could become the standard method for preventing TSIH in high-risk patients. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/24680572/Prophylactic_mesh_vs_suture_in_the_closure_of_the_umbilical_trocar_site_after_laparoscopic_cholecystectomy_in_high_risk_patients_for_incisional_hernia__A_randomized_clinical_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(14)00138-0 DB - PRIME DP - Unbound Medicine ER -