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Primary Mesh Closure of Abdominal Midline Wounds (PRIMA)

This study has been completed.
Baxter Healthcare Corporation
Aesculap AG
Information provided by (Responsible Party):
Hasan Eker, Erasmus Medical Center Identifier:
First received: September 26, 2008
Last updated: October 27, 2016
Last verified: October 2016
Incisional hernia is the most frequently seen long term complication in surgery causing much morbidity and even mortality in patients. Despite studies on the optimal closing technique for laparotomies, the risk for incisional hernia after midline incision remains about 5-20 %. Major risk factors for incisional hernia after a laparotomy, like obesity, steroid use, malnutrition, smoking and connective tissue disorders, are known. Despite this knowledge, there has not yet been developed a sufficient method for prevention. One specific group of high risk patients are patients with an abdominal aortic aneurysm (AAA). The relationship between aortic aneurysm and other abdominal wall hernias, like inguinal hernias, has been reported. Retrospective and prospective studies have shown an average risk for incisional hernia after AAA repair of 31.6 %. Another high risk group is the group of obese patients. Patients with a BMI of more than 27 have a high risk of developing an incisional hernia after midline incision with an incidence of 22% after 12 months. Considering only 50 % of incisional hernia will be clinically evident in the first 12 months, the total incidence will be above 30%. This high risk group of patients with obesitas and aneurysmatic disease can benefit most from prevention. Some small studies have been performed to evaluate the usefulness and safety of primary laparotomy wound closure with the aid of prosthetic mesh. These studies show a very low risk for incisional hernias and a low infection rate, even when used in contaminated wounds such as colostomal surgery. However, there has not been performed an adequate randomized controlled trial to study the prevention of incisional hernias. Our hypothesis is that incisional hernia prevention with use of prosthetic mesh after laparotomy is effective in patients with aortic aneurysm and in obese patients with a BMI of more than 27.

Condition Intervention Phase
Incisional Hernia Occurence
Procedure: mesh supported closure
Procedure: primary closure
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Care Provider, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Primary Mesh Closure of Abdominal Midline Wounds; a Prospective Randomized Multicenter Trial

Resource links provided by NLM:

Further study details as provided by Erasmus Medical Center:

Primary Outcome Measures:
  • incisional hernia occurence [ Time Frame: 2 years ]

Secondary Outcome Measures:
  • complications [ Time Frame: 1 month ]
  • post-operative pain [ Time Frame: 1 month ]
  • quality of life [ Time Frame: 2 years ]

Enrollment: 480
Study Start Date: February 2009
Study Completion Date: April 2015
Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: 1
primary closure of the midline
Procedure: primary closure
primary closure of the midline
Active Comparator: 2
onlay mesh supported closure
Procedure: mesh supported closure
onlay mesh supported closure midline laparotomy
Active Comparator: 3
sublay mesh supported closure
Procedure: mesh supported closure
sublay mesh supported closure midline laparotomy


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Every elective midline laparotomy for patients with Abdominal Aortic Aneurysm and patients with a BMI of more than 27.
  • Signed informed consent

Exclusion Criteria:

  • Age < 18 years
  • Emergency procedure
  • Inclusion in other trials
  • Aortic reconstruction for obstructive disease
  • Life expectancy less than 24 months
  • Pregnant women
  Contacts and Locations
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Please refer to this study by its identifier: NCT00761475

Vienna, Austria
Berlin-Charite Universitatsklinikum
Berlin, Germany
Hamburg-Eppefdorf Universitatsklinikum
Hamburg, Germany
Heidelberg University Medical Center
Heidelberg, Germany
Munchen University Medical Center
Munchen, Germany
Erasmus Medical Center
Rotterdam, Zuid-Holland, Netherlands, 3015 CE
IJsselland Ziekenhuis
Capelle a/d IJssel, Netherlands
Scheper Ziekenhuis
Emmen, Netherlands
Maasstad Ziekenhuis
Rotterdam, Netherlands
Sint Franciscus Gasthuis
Rotterdam, Netherlands
Maxima Medisch Centrum
Veldhoven, Netherlands
Isala klinieken
Zwolle, Netherlands
Sponsors and Collaborators
Erasmus Medical Center
Baxter Healthcare Corporation
Aesculap AG
Principal Investigator: J.F. Lange, Professor Erasmus Medical Center, Rotterdam
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Hasan Eker, Prof. Dr. J.F. Lange, Erasmus Medical Center Identifier: NCT00761475     History of Changes
Other Study ID Numbers: PRIMA TRIAL
Study First Received: September 26, 2008
Last Updated: October 27, 2016

Keywords provided by Erasmus Medical Center:
incisional hernia

Additional relevant MeSH terms:
Incisional Hernia
Pathological Conditions, Anatomical
Postoperative Complications
Pathologic Processes processed this record on May 24, 2017