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Title
Title
• Conventional versus Prophylactic Mesh
placement technique of midline
laparotomy: A comparative study.
Dr. Kameshwar
Assistant Professor
-Dr. Pradeep Pande
Associate Professor
Deptt. Of Surgery
Abstract
Abstract
Background and Objectives
• The midline laparotomy is frequently used
for abdominal surgeries.
• Main complication is incisional hernia.
• The objective of this study is to compare
Mesh Placement Technique with
conventional Mass closure technique in
preventing the incisional hernia
Introduction
Introduction
• Introduction: The median laparotomy is
frequently used by abdominal surgeons to
gain rapid and wide access to the abdominal
cavity with minimal damage to nerves,
vascular structures and muscles of the
abdominal wall. However, incisional hernia
remains the most common complication
after median laparotomy, with reported
incidences varying between 2-20%1.
Introduction
• Median laparotomies and incisional hernias
have been subject of investigation for a long
period of time already. Although a lot is
known about patient related risk factors and
suture materials, technical risk factors such
as suture techniques have not been
investigated thoroughly 2.
Materials and Methods
Materials and Methods
Trial Design
• This trial has been designed as a
prospective, double-blind, randomized
controlled trial, in which Prophylactic
Mesh placementTechnique will be
compared with the conventionally used
large bites mass closure technique for the
closure of midline laparotomy.
Materials and Methods
• 100 consecutive patients reporting to the
department of General Surgery of BRK
Memorial Medical College in whom
midline laparotomy is indicated will be
included in this study.
• These 100 patients will be randomized into
two groups of 50 each.
Materials and Methods
• Group A patients will be managed by
conventional closure of the midline incision
• GroupB patients will be managed by Mesh
placement technique.
• One year after surgery the patients will be
examined for the complication of incisional
hernia clinically and sonographically.
Results: Outcome parameters
Results: Outcome parameters
Primary outcome
• Primary outcome will be incisional hernia
occurrence within one year after surgery,
either clinically and/or ultrasonographically
detected.
Results: Outcome parameters
Secondary outcomes
• Postoperative complications
• Pain
• Quality of life
• Cost effectiveness
Conclusions:
Conclusions:
• The trial will provide level 1b evidence to
support the preference for either a
Prophylactic Mesh placementTechnique
or for the conventionally used large bites
technique
Participants
Participants
• Participants: Patients undergoing midline
laparotomy in BRK Memorial Medical
College Jagdalpur will be included in this
study .
Inclusion criteria:
Inclusion criteria:
• Patients undergoing midline laparotomy in
BRK Memorial Medical College Jagdalpur .
Exclusion criteria
Exclusion criteria
• None
Analysis
Analysis
• Differences between randomized groups
will be tested with appropriate statistical
methods
Conclusion
Conclusion
• This trial is a comparative studyof
Conventional versus Prophylactic Mesh
placement technique of midline laparotomy
closure.
Bibliography
Bibliography
• Muysoms FE, Detry O, Vierendeels
T, Huyghe M, Miserez M, Ruppert
M, Tollens T, Defraigne JO, Berrevoet
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Scientific commitee presentation for paper proposal prophylctic mesh placement.pptx

  • 1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. 7. See notes for bibliography.
  • 3. Title • Conventional versus Prophylactic Mesh placement technique of midline laparotomy: A comparative study. Dr. Kameshwar Assistant Professor -Dr. Pradeep Pande Associate Professor Deptt. Of Surgery
  • 5. Abstract Background and Objectives • The midline laparotomy is frequently used for abdominal surgeries. • Main complication is incisional hernia. • The objective of this study is to compare Mesh Placement Technique with conventional Mass closure technique in preventing the incisional hernia
  • 7. Introduction • Introduction: The median laparotomy is frequently used by abdominal surgeons to gain rapid and wide access to the abdominal cavity with minimal damage to nerves, vascular structures and muscles of the abdominal wall. However, incisional hernia remains the most common complication after median laparotomy, with reported incidences varying between 2-20%1.
  • 8. Introduction • Median laparotomies and incisional hernias have been subject of investigation for a long period of time already. Although a lot is known about patient related risk factors and suture materials, technical risk factors such as suture techniques have not been investigated thoroughly 2.
  • 10. Materials and Methods Trial Design • This trial has been designed as a prospective, double-blind, randomized controlled trial, in which Prophylactic Mesh placementTechnique will be compared with the conventionally used large bites mass closure technique for the closure of midline laparotomy.
  • 11. Materials and Methods • 100 consecutive patients reporting to the department of General Surgery of BRK Memorial Medical College in whom midline laparotomy is indicated will be included in this study. • These 100 patients will be randomized into two groups of 50 each.
  • 12. Materials and Methods • Group A patients will be managed by conventional closure of the midline incision • GroupB patients will be managed by Mesh placement technique. • One year after surgery the patients will be examined for the complication of incisional hernia clinically and sonographically.
  • 14. Results: Outcome parameters Primary outcome • Primary outcome will be incisional hernia occurrence within one year after surgery, either clinically and/or ultrasonographically detected.
  • 15. Results: Outcome parameters Secondary outcomes • Postoperative complications • Pain • Quality of life • Cost effectiveness
  • 17. Conclusions: • The trial will provide level 1b evidence to support the preference for either a Prophylactic Mesh placementTechnique or for the conventionally used large bites technique
  • 19. Participants • Participants: Patients undergoing midline laparotomy in BRK Memorial Medical College Jagdalpur will be included in this study .
  • 21. Inclusion criteria: • Patients undergoing midline laparotomy in BRK Memorial Medical College Jagdalpur .
  • 25. Analysis • Differences between randomized groups will be tested with appropriate statistical methods
  • 27. Conclusion • This trial is a comparative studyof Conventional versus Prophylactic Mesh placement technique of midline laparotomy closure.
  • 29. Bibliography • Muysoms FE, Detry O, Vierendeels T, Huyghe M, Miserez M, Ruppert M, Tollens T, Defraigne JO, Berrevoet
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Editor's Notes

  1. drpradeeppande@gmail.com 7697305442
  2. BACKGROUND: The incidence of incisional hernias after abdominal aortic aneurysm repair is high. Prophylactic mesh-augmented reinforcement during laparotomy closure has been proposed in patients at high risk of incisional hernia. METHODS: A multicenter randomized trial was conducted on patients undergoing elective abdominal aortic aneurysm repair through a midline laparotomy (Clinical.Trials.gov: NCT00757133). In the study group, retromuscular mesh-augmented reinforcement was performed with a large-pore polypropylene mesh (Ultrapro, width 7.5 cm). The primary endpoint was the incidence of incisional hernias at 2-year follow-up. RESULTS: Between February 2009 and January 2013, 120 patients were recruited at 8 Belgian centers. Patients' characteristics at baseline were similar between groups. Operative and postoperative characteristics showed no difference in morbidity or mortality. The cumulative incidence of incisional hernias at 2-year follow-up after conventional closure was 28% (95% confidence interval [CI], 17%-41%) versus 0% (95% CI, 0%-6%) after mesh-augmented reinforcement (P < 0.0001; Fisher exact test). The estimated "freedom of incisional hernia" curves (Kaplan-Meier estimate) were significantly different across study arms (χ = 19.5, P < 0.0001; Mantel-Cox test). No adverse effect related to mesh-augmented reinforcement was observed, apart from an increased mean time to close the abdominal wall for mesh-augmented reinforcement compared with the control group: 46 minutes (SD, 18.6) versus 30 minutes (SD, 18.5), respectively (P < 0.001; Mann-Whitney U test). CONCLUSIONS: Prophylactic retromuscular mesh-augmented reinforcement of a midline laparotomy in patients with abdominal aortic aneurysm is safe and effectively prevents the development of incisional hernia during 2 years, with an additional mean operative time of 16 minutes.
  3. BACKGROUND: The incidence of incisional hernias after abdominal aortic aneurysm repair is high. Prophylactic mesh-augmented reinforcement during laparotomy closure has been proposed in patients at high risk of incisional hernia. METHODS: A multicenter randomized trial was conducted on patients undergoing elective abdominal aortic aneurysm repair through a midline laparotomy (Clinical.Trials.gov: NCT00757133). In the study group, retromuscular mesh-augmented reinforcement was performed with a large-pore polypropylene mesh (Ultrapro, width 7.5 cm). The primary endpoint was the incidence of incisional hernias at 2-year follow-up. RESULTS: Between February 2009 and January 2013, 120 patients were recruited at 8 Belgian centers. Patients' characteristics at baseline were similar between groups. Operative and postoperative characteristics showed no difference in morbidity or mortality. The cumulative incidence of incisional hernias at 2-year follow-up after conventional closure was 28% (95% confidence interval [CI], 17%-41%) versus 0% (95% CI, 0%-6%) after mesh-augmented reinforcement (P < 0.0001; Fisher exact test). The estimated "freedom of incisional hernia" curves (Kaplan-Meier estimate) were significantly different across study arms (χ = 19.5, P < 0.0001; Mantel-Cox test). No adverse effect related to mesh-augmented reinforcement was observed, apart from an increased mean time to close the abdominal wall for mesh-augmented reinforcement compared with the control group: 46 minutes (SD, 18.6) versus 30 minutes (SD, 18.5), respectively (P < 0.001; Mann-Whitney U test). CONCLUSIONS: Prophylactic retromuscular mesh-augmented reinforcement of a midline laparotomy in patients with abdominal aortic aneurysm is safe and effectively prevents the development of incisional hernia during 2 years, with an additional mean operative time of 16 minutes.