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CC BY-NC-ND 4.0 · Aorta (Stamford) 2023; 11(03): 107-111
DOI: 10.1055/s-0043-1771475
Original Research Article

Incisional Hernias after Vascular Surgery for Aortoiliac Aneurysm and Aortoiliac Occlusive Arterial Disease: Has Prophylactic Mesh Changed This Scenario?

Rodrigo Piltcher-da-Silva 
1   General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
4   Postgraduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil
,
Pedro S.M. Soares 
2   Postgraduate Epidemiology Department, Universidade Federal de Pelotas, Pelotas, Brazil
,
Debora O. Hutten 
1   General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
,
Cláudia C. Schnnor 
3   Vascular Surgery Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
,
Isabelle G. Valandro 
1   General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
,
Bruno B. Rabolini 
1   General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
,
Brenda M. Medeiros 
1   General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
,
Rafaela G. Duarte 
1   General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
,
Bernardo S. Volkweis 
1   General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
,
Marco A. Grudtner 
3   Vascular Surgery Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
,
Leandro T. Cavazzola 
1   General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
4   Postgraduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil
› Author Affiliations Funding None
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Abstract

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 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 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 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.

Keywords

hernia - incisional hernia - vascular surgery - aneurysmectomy - abdominal surgery

Supplementary Material



Publication History

Received: 23 August 2022

Accepted: 07 April 2023

Article published online:
24 August 2023

© 2023. 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/)

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