Primary Mesh Closure of Abdominal Midline Wounds
A double blind Randomized Controlled Trial

Incisional hernia is the most common longterm complication in abdominal
surgery. In about 10 to 20 % of all patients receiving abdominal surgery, an
incisional hernia will develop. In teh Netherlands this leads to about 5000
incisional hernia corrections each year.
Some high risk groups have a very incidence of incisional hernia: aortic
aneurysm patients and patients having an BMI larger than 27. About 30 % of
these patients will develop an incisional hernia.
Up to this dat only small studies have been performed to investigate the
effectiveness of preventive mesh placement. The results are hopefull, but a
randomised controlled trial had not yet been performed.

The objective of this study is to evaluate the usefulness of closing the
abdomen with a prosthetic mesh after laparotomy for aortic aneurysm repair or
in patients with a BMI larger than 27 in order to prevent an incisional hernia.
The aim is to reduce the risk of incisional hernia after laparotomy in the
study group from 30 % to 10 %.

This is a double blinded randomized controlled trial. Before surgery, patients
will be randomized either to receive primary closure with a suture or primary
closure with a prosthetic mesh.
A total 480 patients will be randomized into 3 groupes.

During the closure of the abdomen a mesh will be placed on or in the abdominal
wall.

The intervention will take place during surgery and will delay the surgery
approximately 15 minutes. The risks consit of wound complications related to
mesh placement. Surgical site infection and seroma formation are the most
important complications. However, these are mild and respond well to therapy.
The benefit of mesh placement is the reduction of the incidence of incisional
hernia formation from 30 to 10 %.