IP12 - Prophylactic Mesh Reinforcement of Midline Laparotomy for Incisional Hernia Prevention in High-Risk Patients Undergoing Open Abdominal Aortic Aneurysm Repair: A Pilot Prospective Observational Study

Objectives: Incisional hernia represents the most frequent long-term complication following open abdominal aortic aneurysm (AAA) repair, particularly in patients presenting with rectus abdominis diastasis. Preventive strategies implemented during the primary operation may reduce this risk. This pilot study assessed the feasibility, safety, and early outcomes of prophylactic retromuscular mesh placement during open AAA repair in high-risk patients.

Methods: In 2024, a prospective observational pilot study was conducted in patients undergoing elective open AAA repair who demonstrated rectus diastasis, with or without associated umbilical hernia. Procedures were carried out collaboratively by a senior vascular surgeon and a general surgeon specialized in abdominal wall reconstruction. Following AAA repair, abdominal wall reinforcement was performed through rectus sheath reconstruction and insertion of a semi-resorbable, self-anchoring polyester mesh using a Rives-Stoppa retromuscular approach (Figure 1). Prospective cases were matched 1:1 with a historical control group with comparable demographic and clinical characteristics who underwent open AAA repair without mesh reinforcement. The primary endpoint was incisional hernia occurrence at 1-year follow-up. Secondary endpoints included post operative complications classified according to the Clavien–Dindo system, postoperative pain (VAS), analgesic requirements, length of hospital stay, and quality-of-life measures assessed using the SF-36 questionnaire.

Results: Thirty-two patients were evaluated (16 per group). No deaths occurred. The incidence of incisional hernia at 1 year was significantly lower in the mesh group (2/16; 12.5%) compared with controls (11/16; 68.8%; p=0.004). Rates of postoperative complications, pain, and hospital stay were similar between the mesh and no-mesh groups (81.3% vs 93.8%, p=0.47; mean VAS 3.81 vs 4.12, p=0.49; 4.75 vs 4.25 days, p=0.55, respectively). Most of the complications were minor requiring only observation (Table 1). Quality-of-life assessment showed improved physical functioning, vitality, and social activity in the mesh group, with no differences in emotional well-being or perceived pain levels.

Conclusions: In high-risk patients undergoing open AAA repair, prophylactic retromuscular placement of a semi-resorbable mesh is feasible, safe, and significantly reduces the incidence of incisional hernia without increasing postoperative morbidity. Based on this pilot experience, this approach has been adopted as standard practice in our center for patients with high-risk abdominal wall features