Double-blind randomized controlled trial of collagen mesh for the prevention of abdominal incisional hernia in patients having a vertical rectus abdominis myocutaneus flap during surgery for advanced pelvic malignancy.

Autor: Mortensen AR; Department of Surgery, Aarhus University Hospital, Aarhus, Denmark., Grossmann I; Department of Surgery, Aarhus University Hospital, Aarhus, Denmark., Rosenkilde M; Department of Radiology, Aarhus University Hospital, Aarhus, Denmark., Wara P; Department of Surgery, Aarhus University Hospital, Aarhus, Denmark., Laurberg S; Department of Surgery, Aarhus University Hospital, Aarhus, Denmark., Christensen P; Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2017 May; Vol. 19 (5), pp. 491-500.
DOI: 10.1111/codi.13552
Abstrakt: Aim: The study investigated the effect of collagen mesh-assisted closure at the donor site in preventing the formation of incisional hernia following construction of a vertical rectus abdominis myocutaneus (VRAM) flap as part of pelvic surgery for recurrent colorectal cancer.
Method: The study was a double-blinded randomized controlled superiority trial that was designed and performed according to the Consolidated Standards of Reporting Trials (CONSORT) Statement. Eligible patients undergoing surgery that included a VRAM flap for advanced colorectal pelvic malignancy were prospectively randomized to conventional abdominal wound closure or collagen mesh-assisted closure. The primary end-point was incisional herniation at 1 year confirmed by CT. Secondary end-points were CT-verified incisional herniation at 3 and 36 months, clinically recognizable incisional herniation, donor-site and reconstructive-site complications, surgical mortality, postoperative morbidity, postoperative recovery and survival.
Results: In total, 58 (29 conventional closure; 29 mesh-assisted closure) patients were included. At 1 year, incisional herniation on the CT scan was found in 12 (50%) of 24 patients in the conventional closure group, and in 8 (33%) of 24 in the mesh-assisted closure group (P = 0.38). No significant difference between the groups was found in surgical mortality, early or late complications or survival. Donor-site morbidity was comparable between the two groups.
Conclusion: No preventative effect of collagen mesh-assisted closure was observed following VRAM flap reconstruction.
(Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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