2026-04-17T16:21:03Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/138232025-10-24T11:00:05Zcom_2072_451665com_2072_378040col_2072_451666

00925njm 22002777a 4500 dc Ruiz de Leon, Patricia author Gomez Pallarès, Marta author Ciscar Bellés, Ana author Sánchez Sáez, Emma author Vila-Tura, Marina author Troyano Escribano, Daniel author Badia, Josep M author 2025-10-10T12:29:33Z 2025-10-10T12:29:33Z 2024-12 Prophylactic mesh; Hernia; Laparoscopic trocar-site Malla profilàctica; Hèrnia; Lloc de tròcar laparoscòpic Malla profiláctica; Hernia; Sitio de trocar laparoscópico Purpose: Trocar site incisional hernia (TSIH) is a common complication of laparoscopic surgery. In the scientific literature there are few descriptions of methods or tools for its prevention. The aim of this report was to assess the effectiveness and safety of a prophylactic measure designed to lower rates of TSIH. Methods: A multicenter randomized double-blinded clinical trial was performed in high-risk patients (diabetes mellitus and/or age ≥ 70 years and/or BMI ≥ 30 kg/m2 and/or extended incision for specimen retrieval) who underwent either elective or emergency laparoscopic cholecystectomy. Patients were assigned to prophylactic onlay polypropylene mesh fixation (intervention) or to standard trocar closure (control). The main aim was to analyze the efficacy of the intervention, taking occurrence of TSIH as the primary outcome. Clinical and radiological follow up lasted at least one year after surgery. Secondary endpoints were technique-related complications (surgical site occurrences). Results: One hundred and forty-three patients were randomized and finally 116 were analyzed (64 in the intervention arm and 52 in the control arm). Groups were homogeneous. Mean [SD] age, 65 [18] years; 86 (60.6%) were women. The cumulative TSIH incidence was lower in the intervention group although the differences did not reach statistical significance, assessed either radiologically (16 [25.4%] vs 17 [31.5%], p = 0.538) or clinically (9 [16.1%] vs 9 [20], p = 0.613). No differences in surgical site infection, hematoma or seroma were detected. Mean follow-up was 670 days (range 223-1294). Conclusion: Our results show that, when properly assessed, the overall TSIH incidence is extremely high. Although polypropylene onlay mesh placement is safe, it does not appear to be effective in reducing the TSIH incidence rate. Radiological evaluation may be more accurate. This study was funded by Beca per a la Investigació de la Societat Catalana de Cirurgia 2017. http://hdl.handle.net/11351/13823 Hèrnia Laparoscòpia Cirurgia - Complicacions ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Equipment and Supplies::Surgical Equipment::Surgical Mesh DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative Complications DISEASES::Pathological Conditions, Signs and Symptoms::Pathological Conditions, Anatomical::Hernia::Incisional Hernia TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::equipos y suministros::equipo quirúrgico::mallas quirúrgicas ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::complicaciones posoperatorias ENFERMEDADES::afecciones patológicas, signos y síntomas::afecciones patológicas anatómicas::hernia::eventración Assessment of the effectiveness of a polypropylene onlay mesh in the prevention of laparoscopic trocar-site incisional hernia in high-risk patients. A randomized clinical trial