No clear benefit with the use of onlay mesh by vascular surgeons for incisional hernia prevention in patients with abdominal aortic aneurysm repair

Objective The aim of the study was to compare the incidence of IH after abdominal aortic aneurysm (AAA) open repair according to the abdominal wall closure technique used. Methods This is a longitudinal, monocentric, and observational study including patients who underwent AAA open repair by midline laparotomy from January 2019 to December 2021 at our institution. Patients were divided in two groups, fascial closure with small bites and prophylactic mesh reinforcement (Group A); and primary fascial closure with small bites alone (Group B). Primary endpoints were the presence of IH during follow-up in both groups and a comparison represented in a Kaplan-Meier curve. Secondary endpoints were to describe the differences between both groups in surgical wound complications, surgical, hospitalization times, and need for reintervention due to IH. Results Seventy-five patients underwent AAA open repair and 50 were included after exclusions, 23 in group A and 27 in the group B. Patients were followed-up by, at least, one clinical appointment with image test during first 24 month post-surgery. Six (26%) patients in group A and nine (33%) in group B developed IH during the 24-month follow-up ( p = .29). Surgical wound complications were not statistically different, where group A had seven patients (30.4%) and four (14.8%) in group B ( p = .30). No statistically significant differences were found in the surgical time ( p = .59) in both groups. Conclusion In this limited cohort, no statistically significant difference was observed in the occurrence of IH with the use of small-bites primary closure plus mesh versus primary closure with small bites alone at 2-year follow-up. Further studies with larger numbers and adequate design are needed to support the use of mesh for IH prevention as stated in current guidelines.