{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T23:02:07Z","timestamp":1785538927210,"version":"3.56.0"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020422","name":"European Hernia Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020422","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["J. Abdom. Wall Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Incisional hernias (IH) are common complications following emergency midline laparotomies. Mesh reinforcement has shown efficacy in preventing incisional hernias in elective surgeries, but evidence remains limited for emergency midline incisions. This study aimed to evaluate the safety and effectiveness of retrorectus placement of a self-gripping polyester mesh in preventing incisional hernia after emergency midline laparotomy, as measured by the incidence of IH, postoperative complications, quality of life, and health economic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this multicenter randomized controlled trial, adult patients undergoing emergency midline laparotomy were randomized to receive either prophylactic retrorectus mesh or standard 4:1 small-stitch fascial closure using a slowly absorbable monofilament suture. The primary outcome was the radiological\/clinical IH rate within 2\u00a0years after the surgery. Secondary outcomes were complications, reoperations, quality of life, and health-economic measures. Blinding was maintained for patients, outcome assessors, and radiologists. Due to difficulties in recruitment, the study was prematurely terminated prior to reaching the aimed number of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 925 patients screened, 109 were randomized, and 72 received the allocated intervention. At 2-year\u2019s follow-up, one (4%) asymptomatic incisional hernia was detected in the control group compared to none in mesh group. In the mesh group, three (9%) patients experienced mesh-related complications: one (5%) retrorectus hematoma, one (5%) internal hernia and one (5%) postoperative seroma. One (5%) additional patient in the mesh group developed a fistula requiring mesh removal. No significant differences were found in early postoperative complications or quality of life between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Retrorectus mesh reinforcement did not reduce the incidence of incisional hernia compared to standard small-stitch closure in this trial. However, mesh-related complications were observed. Due to recruitment challenges and limited sample size, definitive conclusions cannot be drawn.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/clinicaltrials.gov\/study\/NCT04311788?term=preemer&amp;amp;rank=1<\/jats:ext-link>\n                      , NCT04311788.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/jaws.2025.15500","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T06:10:17Z","timestamp":1764223817000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Prophylactic Retrorectus Mesh Versus Small-Stitch Closure After Emergency Midline Laparotomy: 2-Year Results of a Randomized Controlled Trial"],"prefix":"10.3389","volume":"4","author":[{"given":"E.","family":"M\u00e4k\u00e4r\u00e4inen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Tolonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Sallinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Mentula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Lepp\u00e4niemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Ahonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Saarnio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Pinta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Lampela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Malmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Lietzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Nikki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Ohtonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Muysoms","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Rautio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"B1","first-page":"449","article-title":"Incidence of Incisional Hernia Following Emergency Abdominal Surgery","volume":"31","author":"Mingoli","year":"1999","journal-title":"Ital J Gastroenterol Hepatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1007\/s10029-019-02060-1","article-title":"Is There a Role for Prophylactic Mesh in Abdominal Wall Closure After Emergency Laparotomy? A Systematic Review and meta-analysis","volume":"24","author":"Burns","year":"2020","journal-title":"Hernia"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1007\/s00268-016-3616-9","article-title":"Chronic Pain, Quality of Life, and Functional Impairment After Surgery due to Small Bowel Obstruction","volume":"40","author":"Jeppesen","year":"2016","journal-title":"World J Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s10029-019-01893-0","article-title":"Reduced Rate of Incisional Hernia After Standardized Fascial Closure in Emergency Laparotomy","volume":"23","author":"Thorup","year":"2019","journal-title":"Hernia"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1093\/bjs\/znac302","article-title":"Updated Guideline for Closure of Abdominal Wall Incisions from the European and American Hernia Societies","volume":"109","author":"Deerenberg","year":"2022","journal-title":"Br J Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1007\/s10029-023-02770-7","article-title":"Does Onlay Mesh Placement in Emergency Laparotomy Prevent Incisional Hernia? A Prospective Randomized double-blind Study","volume":"27","author":"U Ulutas","year":"2023","journal-title":"Hernia"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1007\/s00423-021-02421-4","article-title":"Efficacy and Safety of Mesh Closure in Preventing Wound Failure Following Emergency Laparotomy: A Systematic Review and Meta-Analysis","volume":"407","author":"Albendary","year":"2022","journal-title":"Langenbecks Arch Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1093\/bjs\/znab068","article-title":"Prophylactic Sublay Non-Absorbable Mesh Positioning Following Midline Laparotomy in a Clean-contaminated Field: Randomized Clinical Trial (PROMETHEUS)","volume":"108","author":"Pizza","year":"2021","journal-title":"Br J Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1002\/bjs5.50261","article-title":"Prevention of Incisional Hernia After Midline Laparotomy with Prophylactic Mesh Reinforcement: A Meta-Analysis and Trial Sequential Analysis","volume":"4","author":"Jairam","year":"2020","journal-title":"BJS Open"},{"key":"B10","doi-asserted-by":"publisher","first-page":"zrab142","DOI":"10.1093\/bjsopen\/zrab142","article-title":"Prophylactic Retrorectus Mesh Versus No Mesh in Midline Emergency Laparotomy Closure for Prevention of Incisional Hernia (PREEMER): Study Protocol for a Multicentre, double-blinded, Randomized Controlled Trial","volume":"6","author":"M\u00e4k\u00e4r\u00e4inen","year":"2022","journal-title":"BJS Open"},{"key":"B11","volume-title":"ECOG Performance Status Scale","year":"2025"},{"key":"B12","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s004230000182","article-title":"Classification and Surgical Treatment of Incisional Hernia. 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