The outcome of mesh-abdominoplasty in multiparous women with severe musculo-aponeurotic laxity

Abstract

Mahmoud Sakr, Mahmoud Habib, Hossam Hamed, Hassan Kholosy

Objective: To assess the outcome of Prolene mesh-abdominoplasty, as compared to abdominoplasty alone, in multipa-rous women with severe musculo-aponeurotic laxity.Subjects and Methods: The present retrospective study included 135 multiparous (4 or more children) women who pre-sented with an abdomen that resembled a full-term pregnancy in the erect posture. Their ages ranged between 27 and 59 years with a mean of 41.26±13.15 years. Forty-three (31.9%) patients suffered from low back pain, 52 patients (38.52%) had an associated ventral hernia, and 88 (65.19%) had previous abdominal surgery. Eighty-four patients (62.2%) under-went mesh-abdominoplasty (Group 1) while the remaining 51 (37.8%), who refused mesh application, underwent standard abdominoplasty (Group 2). The follow-up period ranged from18 months to 11 years with an average of 61 months. Results: Both groups were comparable regarding their demographic and clinical parameters. All repaired hernias did not recur, and abdominal pain was relieved in all patients of both groups. With mesh-abdominoplasty, low-back pain was completely relieved in 71.4% (20/28) of patients as compared to 80% (12/15) with abdominoplasty. No mortality or major complications were encountered. Wound complications occurred in 22 patients (26.19%) in Group 1 versus 7 (13.73%) in Group 2 (X2=2.923, p=0.087). With mesh-abdominoplasty (Group 1), ten patients (11.90%) required a second operation for refashioning of lower abdominal skin laxity, dog-ears or umbilical scar as compared to 16 patients (31.37%) in patients with abdominoplasty only (Group 2) (X2=7.734, p=0.005). Recurrence was significantly higher among patients who under-went abdominoplasty alone (X2=22.768, p<0.00001). Conclusions: It is suitable to use the Prolene mesh routinely during abdominoplasty for multiparous patients with severe musculo-aponeurotic laxity as, in addition to relief of symptoms and minimal complications, it yielded lower recurrence and less refashioning procedures than abdominoplasty alone.