Short-term outcomes in mesh versus suture-only treatment of burst abdomen: a case-series from a university hospital

PURPOSE: Surgery for a burst abdomen after midline laparotomy is associated with later incisional hernia formation. Accommodating prophylactic measures, notably mesh augmentation, are of interest. However, data regarding safety and outcomes are scarce. This study aimed to evaluate the short-term risk profile of mesh prophylaxis in the context of a burst abdomen.

METHODS: This is a single-center prospective study of patients suffering from burst abdomen from 2021 to 2023. A treatment protocol for the management of burst abdomen was introduced, including the synthetic, partially absorbable onlay mesh. Adult patients (≥ 18 years) with a life expectancy of > 1 year with no plans of future pregnancies were recommended to be treated with a prophylactic mesh. In this analysis, adult patients were included if they suffered from a burst abdomen after elective or emergency laparotomy. The study evaluates short-term outcomes, including 90-day wound complications, length of stay, and mortality.

RESULTS: Sixty-seven patients fulfilled the inclusion criteria and underwent treatment for a burst abdomen during the study period. Thirty-eight patients were treated with a suture-only technique, and 29 patients were supplemented with a mesh. 13 of 14 observed wound complications in the mesh group were of mild degree (Clavien Dindo 1-3b), while one patient (3%) needed mesh-explantation. The 90-day mortality rate was 21% and comparable between suture-only and mesh techniques.

CONCLUSION: Mesh augmentation in surgery for a burst abdomen seems safe in well-selected patients at 90 days follow-up. Long-term data on the prophylactic effect on hernia development is needed.