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Prophylactic mesh to prevent incisional hernia in laparotomy for ovarian tumors
  1. Berta Fabregó1,
  2. Ester Miralpeix1,
  3. Josep-Maria Sole-Sedeno1,
  4. José-Antonio Pereira2,3 and
  5. Gemma Mancebo1
    1. 1Department of Obstetrics and Gynecology, Hospital del Mar, Hospital del Mar, Barcelona, Catalunya, Spain
    2. 2Department of Surgery, Hospital del Mar, Barcelona, Spain
    3. 3Pompeu Fabra University, Barcelona, Spain
    1. Correspondence to Gemma Mancebo, Department of Obstetrics and Gynaecology, Hospital del Mar, Barcelona, Spain; GMancebo{at}parcdesalutmar.cat

    Abstract

    Objective Incisional hernias are a common complication of midline laparotomies. The aim of this study was to determine the impact of prophylactic mesh placement after midline laparotomy for ovarian tumors on the incidence of incisional hernia.

    Methods We collected retrospective data from patients undergoing midline laparotomy for borderline or ovarian cancer with at least 12 months of follow-up, including those with and without mesh. Patient demographics, preoperative characteristics and risk factors for hernia were reported and grouped according to prophylactic mesh placement. A multivariate analysis was conducted to identify independent risk factors for incisional hernia. Kaplan–Meier curves illustrating the cumulative incidence of incisional hernia based on mesh placement were performed.

    Results A total of 139 consecutive patients with available data were included, 58 in the non-mesh group and 81 in the mesh group, with high body mass index (BMI) as the most common reason for mesh placement. The mean (SD)) age was 60 years (13.97). A total of 11 patients (7.9%) had borderline tumors while 128 (92.1%) had invasive cancer. After clinical and radiological examination, 18.7% (26/139) of patients developed incisional hernia at a median follow-up of 35.8 months (IQR) 43.8): 31% (18/58) were detected in the non-mesh group, and 9.9% (8/81) in the mesh group (p<0.002). Multivariate analysis showed no-mesh placement (OR) 10; 95% CI) 2.8 to 35.919; p<0.001) as a significant risk factor for incisional hernia. Age ≥70 (OR 4.3; 95% CI 1.24 to 15; p=0.02) and BMI ≥29 (OR 4.4; 95% CI 1.27 to 14.93; p=0.019) were also identified as independent risk factors for hernia development. According to Kaplan–Meier curves, the cumulative incidence of incisional hernia was higher in the non-mesh group (p=0.002).

    Conclusion The incidence of incisional hernia was high in patients undergoing midline laparotomy for ovarian tumors. The addition of a prophylactic mesh may reduce this incidence, therefore there is a need to consider it as an option for high-risk patients, particularly those aged over 70 years or with a BMI ≥29 kg/m2.

    • Ovarian Cancer
    • Laparotomy
    • Postoperative complications

    Data availability statement

    Data are available upon reasonable request. Datasets are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request. Datasets are available upon reasonable request.

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    Footnotes

    • Presented at This manuscript has been previously published as a preprint: Fabregó, Miralpeix, Solé-Sedeño, Pereira, Mancebo. Prevention of Incisional Hernia in Ovarian Cancer Patients Undergoing Midline Laparotomy (2021). https://www.researchsquare.com/article/rs-1020551/v1. DOI: https://doi.org/10.21203/rs.3.rs-1020551/v1

    • Contributors Study concepts: BF, EM, JSS, JP, GM; Study design: BF, EM, JSS, JP, GM; Data acquisition: BF, EM; Quality control of data and algorithms: BF, EM, JSS, JP, GM; Data analysis and interpretation: BF, EM, GM; Statistical analysis: EM; Manuscript preparation: BF, EM, JSS, JP, GM; Manuscript editing: BF, EM; Manuscript review: BF, EM, JSS, JP, GM. All authors read and approved the final manuscript. Guarantor: BF.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.