Prevention of incisional hernia in ileostomy reversal. 5-year follow-up prospective randomized controlled trial.

PURPOSE: The aim of the study is to analyze the long-term protective effect (5 years) of associating an onlay mesh in the closure of the loop ileostomy closure incision. MATERIAL & METHODS: Multicenter, prospective, randomized, controlled study including patients undergoing lateral ileostomy closure. In the control group, the incision closure was performed using continuous 4:1 polydioxanone suture. In the study group, after the same type of closure, a light polypropylene onlay mesh was placed. The presence of incisional hernia is evaluated by physical examination and CT at 1 and 5 years of follow-up. RESULTS: 58 patients were included (27 in control group and 31 in mesh group). Both groups had similar basal characteristics. At the 12-month follow-up, 3 incisional hernias (11%) were detected in the control group, while none were observed in the mesh group. The difference did not reach statistical significance. At 5 years of follow-up, no incisional hernia was observed in the mesh group, compared to 5 in the control group (18.5%), with 2 more cases appearing compared to the control of the first 12 months, and achieving statistical significance. In the control group, 2 patients required surgery for their incisional hernia. No long-term mesh-related complications have been observed. CONCLUSIONS: The protective effect of associating an onlay mesh is maintained in the long term in the closure of this type of interventions, with greater differences compared to the control group. Long-term follow-up is necessary in these studies. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02896686. 2016–09-12.