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A two-year trial has reported a significant reduction in the incidence of incisional hernia being achieved with the reinforcement of onlay mesh, compared with just sublay mesh reinforcement and primary suture.

Incisional hernia is known to be a common long-term complication post abdominal surgery and those in a high-risk category develop it with a prevalence of 30 per cent.

The PRIMA trial evaluated the effectiveness of mesh reinforcement in such high-risk patients in an effort to stop the occurrence of incisional hernia.

Randomised controlled trials were done in multiple centres; 11 hospitals were included spread around Austria, Germany, and the Netherlands.

The patients were aged 18 years or older, were undergoing an elective midline laparotomy, and either had an abdominal aortic aneurysm or a body-mass index (BMI) of 27 kg/m² or higher.

Participants were randomly assigned to three separate treatment groups by a computer-generated sequence. The groups were; primary suture, onlay mesh reinforcement, or sublay mesh reinforcement.

The incidence of incisional hernia was then followed-up over two years, between March, 2009, and December, 2012.

Of the 480 patients included in the primary analysis: 107 received primary suture, 188 were allocated onlay mesh reinforcement, while 185 were treated with sublay mesh reinforcement.

92 patients experienced an incisional hernia, 33 (30 per cent) of whom were allocated primary suture only, 25 (13 per cent) had the onlay mesh reinforcement, and 34 (18 per cent) were assigned sublay mesh reinforcement.

The report, published in the Lancet earlier this month, concluded that onlay mesh reinforcement could potentially become the standard treatment for high-risk patients undergoing midline laparotomy.

DOI: http://dx.doi.org/10.1016/S0140-6736(17)31332-6.