***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Incisional hernia is one of the most frequent postoperative complications after abdominal surgery .  Patients with an abdominal aortic aneurysm and patients with a body mass index of 27 or higher have an increased risk to develop incisional hernia .  Primary mesh augmentation is a method in which the abdominal wall is strengthened to reduce incisional hernia incidence . This study focused on the short-term results of the PRImary Mesh Closure of Abdominal Midline Wounds trial , a multicenter double blind r and omized controlled trial . METHODS Between 2009 and 2012 patients were included if they were operated via midline laparotomy , and had an abdominal aortic aneurysm or a body mass index of 27 or higher . Patients were r and omly assigned to either receive primary suture , onlay mesh augmentation ( OMA ) , or sublay mesh augmentation . RESULTS Outcomes represent results after 1-month follow-up . A total of 480 patients were r and omized . During analysis , significantly ( P = 0.002 ) more seromas were detected after OMA ( n = 34 , 18.1 % ) compared with primary suture ( n = 5 , 4.7 % ) and sublay mesh augmentation ( n = 13 , 7 % ) . No differences were discovered in any of the other outcomes such as surgical site infection , hematoma , reintervention , or readmission . Multivariable analysis revealed an increase in seroma formation after OMA with an odds ratio of 4.3 ( P = 0.004 ) compared with primary suture and an odds ratio of 2.9 ( P = 0.003 ) compared with sublay mesh augmentation . CONCLUSIONS On the basis of these short-term results , primary mesh augmentation can be considered a safe procedure with only an increase in seroma formation after OMA , but without an increased risk of surgical site infection BACKGROUND Incisional hernia is an important complication of abdominal surgery . Procedures for the repair of these hernias with sutures and with mesh have been reported , but there is no consensus about which type of procedure is best . METHODS Between March 1992 and February 1998 , we performed a multicenter trial in which we r and omly assigned to suture repair or mesh repair  200 patients who were scheduled to undergo repair of a primary hernia or a first recurrence of hernia at the site of a vertical midline incision of the abdomen of less than 6 cm in length or width . The patients were followed up by physical examination at 1 , 6 , 12 , 18 , 24 , and 36 months . Recurrence rates and potential risk factors for recurrent incisional hernia were analyzed with the use of life-table methods . RESULTS Among the 154 patients with primary hernias and the 27 patients with first-time recurrent hernias who were eligible for the study , 56 had recurrences during the follow-up period . The three-year cumulative rates of recurrence among patients who had suture repair and those who had mesh repair were 43 percent and 24 percent , respectively , with repair of a primary hernia ( P=0.02 ; difference , 19 percentage points ; 95 percent confidence interval , 3 to 35 percentage points ) . The recurrence rates were 58 percent and 20 percent with repair of a first recurrence of hernia ( P=0.10 ; difference , 38 percentage points ; 95 percent confidence interval , -1 to 78 percentage points ) . The risk factors for recurrence were suture repair , infection , prostatism ( in men ) , and previous surgery for abdominal aortic aneurysm . The size of the hernia did not affect the rate of recurrence . CONCLUSIONS Among patients with midline abdominal incisional hernias , mesh repair is superior to suture repair with regard to the recurrence of hernia , regardless of the size of the hernia Objective : The objective of this study was to determine the best treatment of incisional hernia , taking into account recurrence , complications , discomfort , cosmetic result , and patient satisfaction . Background : Long-term results of incisional hernia repair are lacking . Retrospective studies and the midterm results of this study indicate that mesh repair is superior to suture repair . However , many surgeons are still performing suture repair . Methods : Between 1992 and 1998 , a multicenter trial was performed , in which 181 eligible patients with a primary or first-time recurrent midline incisional hernia were r and omly assigned to suture or mesh repair .  In 2003 , follow-up was up date d. Results : Median follow-up was 75 months for suture repair and 81 months for mesh repair patients . The 10-year cumulative rate of recurrence was 63 % for suture repair and 32 % for mesh repair ( P < 0.001 ) . Abdominal aneurysm ( P = 0.01 ) and wound infection ( P = 0.02 ) were identified as independent risk factors for recurrence . In patients with small incisional hernias , the recurrence rates were 67 % after suture repair and 17 % after mesh repair ( P = 0.003 ) . One hundred twenty-six patients completed long-term follow-up ( median follow-up 98 months ) . In the mesh repair group , 17 % suffered a complication , compared with 8 % in the suture repair group ( P = 0.17 ) . Abdominal pain was more frequent in suture repair patients ( P = 0.01 ) , but there was no difference in scar pain , cosmetic result , and patient satisfaction . Conclusions : Mesh repair results in a lower recurrence rate and less abdominal pain and does not result in more complications than suture repair . Suture repair of incisional hernia should be ab and oned BACKGROUND Laparotomy wound load forces are reduced when dehiscence and incisional hernia formation occur . The purpose of this study was to determine the effects of strain loss on abdominal fascial  fibroblast proliferation , orientation , and collagen compaction function . METHODS Cultured rat linea alba fibroblasts were subjected to continuous cyclic strain ( CS ) , CS interrupted at 24 or 48 hours followed by culture at rest ( IS-24 and IS-48 ) or were cultured without mechanical strain ( NS ) . Cell number was measured and images analyzed for cell orientation . Fibroblasts from these groups were seeded onto the surface of ( FPCL-S ) or mixed into ( FPCL-M ) a collagen gel matrix and gel area was measured over time . RESULTS Continuous strain stimulated proliferation when compared with the nonstrained cells . The loss of strain ( IS ) delayed proliferation compared with CS throughout ( P < .05 ) . CS fibroblasts aligned perpendicular to the direction of strain within 12 hours . Within 12 hours of strain loss , IS-48 fibroblasts became significantly less aligned ( P < .0001 ) , and seemed similar to the r and omly organized NS fibroblasts 48 hours after strain removal . The CS and IS-24 groups demonstrated faster and greater overall FPCL-M compaction than both the IS-48 and NS groups ( P < .0002 ) . The CS group contracted the gel faster than the NS group in FPCL-S ( P = .029 ) . CONCLUSION Mechanical strain rapidly induces a proliferative , morphologic , and functional response in abdominal wall fibroblasts that is dependent on the continued presence of the strain signal and quickly lost when the load force is removed . The loss of wound edge tension that occurs during laparotomy wound separation and hernia formation may contribute to impaired wound healing through loss of a key stimulatory mechanical signal with important implication s for abdominal wall reconstruction Background / aim Incisional hernia is one of the major elements of morbidity after abdominal surgery , with high incidence in vertical midline abdominal incisions . However , the risk of developing an incisional hernia can be increased due to the patient ’s related factors ; therefore , more consideration has to be given to the choice of incision , wound closure and wound healing to protect against incisional hernia , especially in high-risk patients . In this study , we used prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients to detect whether fixing the wound with mesh is risky on a short-term basis and whether it is protective on a long-term basis . Patients and methods From October 2000 to December 2002 , 40 high-risk patients liable to develop postoperative incisional hernia underwent elective abdominal operations through midline abdominal incisions at the Department of Surgery , Gastroenterology and Laparoscopic Unit , Tanta University Hospital , Egypt . They were r and omly divided into two groups ; group A : patients for whom the  midline abdominal incisions were closed by conventional method and reinforced by subfascial polypropylene mesh ( 20 patients ) ; and group B : patients for whom the midline abdominal incisions were closed by conventional method only ( 20 patients ) with a follow up period of more than 20 months . Results There was no significant difference ( P = 0.075 ) in both groups regarding the age , sex and the average risk factor . Twenty-three patients ( 57.5 % ) presented with more than one risk factor ( 11 in group A and 12 in group B ) . The upper midline abdominal incisions were reported in 33 patients ( 19 upper and 14 extended upper ) . There was no significant difference between the overall local and systemic complications in both groups ( P = 0.4082 ) . However , the subcutaneous seroma and chronic wound pain were greater in patients with prophylactic mesh than those without mesh . One group A patients ( 5 % ) and three group B patients ( 15 % ) developed postoperative incisional hernia during the follow up period . Conclusion Prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients can be used safely and effectively to provide extrinsic strength of the wound without relying too much on the defective development of its own intrinsic strength and to prevent subsequent incisional hernia . There was no risk in the use of the mesh regarding local and systemic complication . However , the final statement should await the outcomes of the long-term follow up of the studied cases Background Incisional hernia is the most frequently seen long term complication after laparotomy causing much morbidity and even mortality . The overall incidence remains 11 - 20 % , despite studies attempting to optimize closing techniques . Two patient groups , patients with abdominal aortic aneurysm and obese patients , have a risk for incisional hernia after laparotomy of more than 30 % . These patients might benefit from mesh augmented midline closure as a means to reduce incisional hernia incidence . Methods / design The PRImary Mesh Closure of Abdominal Midline Wound ( PRIMA ) trial is a double-blinded international multicenter r and omized controlled trial comparing running slowly absorbable suture closure with the same closure augmented with a sublay or onlay mesh . Primary endpoint will be incisional hernia incidence 2 years postoperatively . Secondary outcomes will be postoperative complications , pain , quality of life and cost effectiveness .  A total of 460 patients will be included in three arms of the study and r and omized between running suture closure , onlay mesh closure or sublay mesh closure . Follow-up will be at 1 , 3 , 12 and 24 months with ultrasound imaging performed at 6 and 24 months to objectify the presence of incisional hernia . Patients , investigators and radiologists will be blinded throughout the whole follow up . DisccusionThe use of prosthetic mesh has proven effective and safe in incisional hernia surgery however its use in a prophylactic manner has yet to be properly investigated . The PRIMA trial will provide level 1b evidence whether mesh augmented midline abdominal closure reduces incisional hernia incidence in high risk groups . Trial registration Clinical trial.gov NCT00761475 Incisional hernia continues to be a serious postoperative complication in abdominal surgery . We present a prospect i ve r and omised study to evaluate the usefulness of placement of a supra-aponeurotic polypropylene mesh in the primary closure of laparotomies with a high risk of incisional hernia . Closure of a vertical laparotomy in 100 patients was accomplished with continuous suture using non-reabsorbable material , with placement of a polypropylene mesh on the aponeurotic surface in 50 patients . Three years after surgery , five patients in the group without the mesh had suffered incisional hernia . No incisional hernia was detected in the group in which closure was made using the mesh ( P=0.02 ) . Use of prosthetic material ( polypropylene mesh ) in the primary closure of laparotomies with a high risk of incisional hernia is useful for reduction of the rate of incisional hernias Background The occurrence of incisional hernias after various types of abdominal procedures and incisions continues to be a problem . A number of studies conducted for diverse risk groups have identified a beneficial role for the prophylactic use of mesh augmentation . To what extent this affects the stability of a suture was tested in our biomechanical model . Material s and methods To that effect , we compared three groups , carrying out six measurements in each case : ( 1 ) single suture in a muscle specimen , ( 2 ) suture and additional reinforcement with fibrin glue , and ( 3 ) suture and additional reinforcement with a mesh fixed with fibrin glue ( Tissucol , Tisseel ; with an overlap of 2 cm to all sides ) . Results The single suture conferred a tensile strength , which in our model , was just above the prescribed maximum abdominal pressure of 32 N ( 37.3 N ) . The additional use of fibrin glue did not have any significant impact 
    Output:
    
PSC was associated with an incremental cost-efficacy ratio ( ICER ) of -$42,444/QALY compared with PMA such that PMA was more effective and less costly .
Monte Carlo sensitivity analysis was performed demonstrating more simulations result ing in ICERs for PSC above the willingness-to-pay threshold of $ 50,000/QALY , supporting the finding that PMA is superior .
Cost-utility analysis of PSC compared to PMA for abdominal laparotomy closure demonstrates PMA to be more effective , less costly , and overall more cost-effective than PSC