A comparative study of sutured versus bovine pericardium mesh abdominal closure after open abdominal aortic aneurysm repair.

BACKGROUND: Open abdominal aortic aneurysm (AAA) repair is followed by a high rate of incisional herniation. The purpose of this study was to evaluate whether this postoperative complication could be avoided by a prophylactic implantation of a biological mesh.

METHODS: In a prospective randomized clinical study, patients electively treated by open AAA repair were allocated equally to routine abdominal suture closure or to prophylactic placement of bovine pericardium mesh above the fascia. The study end points were postoperative complications and incidence of incisional hernia at a 3-year follow up.

RESULTS: Forty patients with a mean age of 74.3 (SD ± 5.8) years were studied. All patients had a successful operation and a quite uneventful postoperative course. The mean operative time in the mesh group was longer compared to the control group (p < 0.001). Two patients in the mesh group developed wound seroma postoperatively. Six patients (30%) in the control group developed incisional hernia comparing to none in the mesh group. Cumulative proportion of freedom from incisional hernia was 100% for mesh group at 3 years and 74.4% (SE 9.9%) for control group at 2 years (p < 0.008). In five patients (83%), the incisional hernia was diagnosed by the second postoperative year. One patient underwent incisional hernia repair.

CONCLUSION: The bovine pericardium mesh reinforcement of fascia closure in patients undergoing open AAA repair showed effectiveness and low complication rate in prophylaxis from incisional herniation. It should be considered as an alternative mesh material in selected patients.