Prophylactic mesh reinforcement after open aortic aneurysm repair: a prospective cohort study

Raffaella Sguinzi^1,2*Melissa Lagger¹Theo Chevalley²Benoit Gremaud²Markus Menth¹Leo Buhler¹Michel Adamina^1,2

• ¹HFR Fribourg Hopital cantonal, Villars-sur-Glâne, Switzerland
• ²Universite de Fribourg Section de medecine, Fribourg, Switzerland

Patients undergoing elective open abdominal aortic aneurysm (AAA) repair via midline laparotomy are at significantly increased risk -up to threefold -of developing incisional hernias (IH) compared to those treated for aorto-iliac occlusive disease using the same approach.Recent vascular surgery guidelines recommend prophylactic mesh reinforcement (PMR) during abdominal wall closure to reduce IH incidence. This study aims at evaluating the effectiveness of retromuscular PMR in preventing IH following open AAA repair and to assess related postoperative complications.with retromuscular PMR at our institution. Data collection included patient demographics, operative details, and postoperative complications. Clinical examination, abdominal ultrasound, and quality of life (QoL) were routinely assessed to evaluate the presence of IH and patientreported outcomes. The primary endpoint was the incidence of IH; secondary outcomes included fascial dehiscence, seromas, surgical site infections (SSI), hematomas, chronic pain and mesh displacement. Descriptive statistics were used to report outcomes, and findings were compared with existing literature.Results. Twenty-one patients were included between 2019 and 2024 with a median follow-up of 32 months. IH occurred in 4 patients (19%), of those 3 developed hernias following a relaparotomy performed post-operatively with mesh incision and re-closure, and one was detected on ultrasound without clinical symptoms. No cases of fascial dehiscence, seroma, or surgical site infection were reported nor chronic pain or mesh displacement. QoL was well preserved, with minimal functional limitations and an average general health score of 80%.Retromuscular PMR may reduce the incidence of IH after open AAA repair. Relaparotomy appears to be a risk factor for hernia development. While these results support current guideline recommendations, further data with larger cohorts are needed to confirm these findings.