Prophylactic Intraperitoneal Onlay Mesh Following Midline Laparotomy-Long-Term Results of a Randomized Controlled Trial

World J Surg. 2019 Jul;43(7):1669-1675. doi: 10.1007/s00268-019-04964-6.


Objectives: Incisional hernia, a serious complication after laparotomy, is associated with high morbidity and costs. This trial examines the value of prophylactic intraperitoneal onlay mesh to reduce the risk of incisional hernia after a median follow-up time of 5.3 years.

Methods: We conducted a parallel group, open-label, single center, randomized controlled trial (NCT01003067). After midline incision, the participants were either allocated to abdominal wall closure according to Everett with a PDS-loop running suture reinforced by an intraperitoneal composite mesh strip (Group A) or the same procedure without the additional mesh strip (Group B).

Results: A total of 276 patients were randomized (Group A = 131; Group B = 136). Follow-up data after a median of 5.3 years after surgery were available from 183 patients (Group A = 95; Group B = 88). Incisional hernia was diagnosed in 25/95 (26%) patients in Group A and in 46/88 (52%) patients in Group B (risk ratio 0.52; 95% CI 0.36-0.77; p < 0.001). Eighteen patients with asymptomatic incisional hernia went for watchful waiting instead of hernia repair and remained free of symptoms after of a median follow-up of 5.1 years. Between the second- and fifth-year follow-up period, no complication associated with the mesh could be detected.

Conclusion: The use of a composite mesh in intraperitoneal onlay position significantly reduces the risk of incisional hernia during a 5-year follow-up period.

Trial registration number: Ref. NCT01003067 (

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen / surgery
  • Abdominal Wound Closure Techniques*
  • Follow-Up Studies
  • Hernia, Ventral / etiology
  • Hernia, Ventral / prevention & control*
  • Hernia, Ventral / surgery
  • Herniorrhaphy
  • Humans
  • Incisional Hernia / etiology
  • Incisional Hernia / prevention & control*
  • Incisional Hernia / surgery
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Postoperative Complications / surgery
  • Surgical Mesh* / adverse effects
  • Sutures

Associated data