ABSTRACT
BACKGROUND: Prevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies. METHODS: This study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared. RESULTS: From an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62 vs. 43.2%; P = 0.01) and operation due to a revision laparotomy (32.5 vs.13%; P = 0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P = 0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR = 2.47; 95% CI 1.318-4.624; P = 0.05), contaminated surgery (HR = 2.98; 95% CI 1.142-7.8; P = 0.02), surgical site infection (SSI; HR = 3.83; 95% CI 1.86-7.86; P = 0.001), and no use of prophylactic mesh (HR = 5.09; 95% CI 2.1-12.2; P = 0.001). CONCLUSION: Incidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and surgical site infection (SSI) benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate. TRIAL REGISTRATION: NCT04578561. www.clinicaltrials.gov.
Subject(s)
Incisional Hernia , Laparotomy , Emergencies , Follow-Up Studies , Humans , Incisional Hernia/epidemiology , Incisional Hernia/etiology , Incisional Hernia/prevention & control , Laparotomy/adverse effects , Retrospective Studies , Surgical MeshABSTRACT
The effect of postprandial administration of a new formulation of almagate (1.5 g, po) or an association of alginate + antacid (2.4 g, po) on gastric alkalinization and gastroesophageal reflux were assessed in a randomized, single-blind, cross-over study in 21 patients with gastroesophageal reflux disease. Continuous intragastric and esophageal acidity was evaluated by postprandial intraluminal pHmetry. When comparing both preparations, the new formulation of almagate significantly improved all pHmetric variables (number of reflux episodes (3 vs 6, p = 0.029), time of esophageal exposition to pH < 4.0 (1vs 9 minutes, p = 0.009), duration of longest reflux episode (1 vs 3 minutes, p = 0.036), reflux index (1 vs 2, p = 0.047), and intragastric time with pH greater than 4.0 (108 vs 46 minutes, p = 0.003). This results suggest that the new formulation of almagate could be effective in the treatment of gastroesophageal reflux disease, since acidity profile of patients treated with it have been shown an intragastric long-lasting alkalinization wave.
