***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 Open abdominal aortic aneurysm ( AAA ) repair is followed by a high rate of incisional herniation . The purpose of this study was to evaluate whether this postoperative complication could be avoided by a prophylactic implantation of a biological mesh . Methods In a prospect i ve r and omized clinical study , patients electively treated by open AAA repair were allocated equally to routine abdominal suture closure or to prophylactic placement of bovine pericardium mesh above the fascia . The study end points were postoperative complications and incidence of incisional hernia at a 3-year follow up . Results Forty patients with a mean age of 74.3 ( SD ± 5.8 ) years were studied . All patients had a successful operation and a quite uneventful postoperative course . The mean operative time in the mesh group was longer compared to the control group ( p < 0.001 ) . Two patients in the mesh group developed wound seroma postoperatively . Six patients ( 30 % ) in the control group developed incisional hernia comparing to none in the mesh group . Cumulative proportion of freedom from incisional hernia was 100 % for mesh group at 3 years and 74.4 % ( SE 9.9 % ) for control group at 2 years ( p < 0.008 ) . In five patients ( 83 % ) , the incisional hernia was diagnosed by the second postoperative year . One patient underwent incisional hernia repair . Conclusion The bovine pericardium mesh reinforcement of fascia closure in patients undergoing open AAA repair showed effectiveness and low complication rate in prophylaxis from incisional herniation . It should be considered as an alternative mesh material in selected patients BACKGROUND Assessing incisional hernia recurrence typically requires a clinical encounter . We sought to determine if patient-reported outcomes ( PROs ) could detect long-term recurrence . METHODS Adult patients 1 to 5 years after incisional hernia repair were prospect ively asked about recurrence , bulge , and pain at the original repair site . Using dynamic abdominal sonography for hernia to detect recurrence , performance of each PRO was determined . Multivariable regression was used to evaluate PRO association with recurrence . RESULTS Fifty-two patients enrolled with follow-up time 46 ± 13 months . A patient-reported bulge was 85 % sensitive , and 81 % specific to detect recurrence . Patients reporting no bulge and no pain had 0 % chance of recurrence . In multivariable analysis , patients reporting a bulge were 18 times more likely to have a recurrence than those without ( 95 % confidence interval , 3.7 to 90.0 ; P < .001 ) . CONCLUSIONS This preliminary study demonstrates that PROs offer a promising means of detecting long-term recurrence  after incisional hernia repair , which can help facilitate quality improvement and research efforts BACKGROUND Development of an incisional hernia is one of the most frequent complications of midline laparotomies requiring reoperation . This paper presents the rationale , design , and study protocol for a r and omized controlled trial , the aim of which is to evaluate the efficacy and safety of prophylactically placing a bioabsorbable synthetic mesh for reinforcement of a midline fascial closure . METHODS The PREBIOUS trial ( PREventive midline laparotomy closure with a BIOabsorbable mesh ) is a multicenter r and omized controlled trial in which adult patients undergoing elective or urgent open abdominal operations through a midline laparotomy incision are assigned to one of two groups based on the laparotomy closure procedure : an intervention group in which a continuous polydioxanone ( PDS ) suture is reinforced with a commercially available GORE ® BIO-A ® Tissue Reinforcement prosthesis ( W.L. Gore & Associates , Flagstaff , AZ , USA ) , or a control group with continuous PDS suture only . Both groups are followed over 6 months . OUTCOMES The primary outcome is the appearance of incisional hernias assessed by physical examination at clinical visits and radiologically ( CT scan ) performed at the end of follow-up . Secondary outcomes are the rate of complications , mainly infection , hematoma , burst abdomen , pain , and reoperation . The PREBIOUS trial has the potential to demonstrate that suture plus prosthetic mesh insertion for routine midline laparotomy closure is effective in preventing incisional hernias after open abdominal surgery , to avoid the effects on those affected , such as poor cosmesis , social embarrassment , or impaired quality of life , and to save costs potentially associated with incisional hernia surgical repair 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 Abstract Background . Incisional hernia is a common problem following  Roux-en-Y gastric bypass for morbid obesity . Patients and material s. We report the preliminary results of nonr and omized prophylactic use of polypropylene mesh in a group of 60 consecutive patients . The patients with highest body mass index , and /or history of abdominal hernias and profound liver damage had abdominal wall reinforced with mesh during an operation . A year later the wound was assessed in all patients . Results . In st and ard wound closure group ( n=48 ) incisional hernia was found in 9 cases ( 20 % ) . None of the patients with inserted mesh ( n=12 ) developed hernia . The length of hospital stay in mesh group was similar to that in the nonmesh group and shorter than in patients with hernia occurrence .  Mesh insertion was complicated with wound discharge in three patients . Conclusions . In our opinion prophylactic use of polypropylene mesh in bariatric patients is highly effective in postoperative hernia prevention Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more 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 
    Output:
    
Prophylactic mesh placement is associated with an 85 % postoperative incisional hernia risk reduction when compared to primary suture closure in at‐risk patients undergoing elective , midline laparotomy closure .
This technique appears to be safe with comparable complication profiles , barring an increased risk of seroma , especially with the onlay technique , and the possibility for an increased risk of chronic pain .