Abdominal Closure and the Risk of Incisional Hernia in Aneurysm Surgery – A Systematic Review and Meta-analysis

Nicolajsen, Chalotte Winther; Eldrup, Nikolaj

doi:10.1016/j.ejvs.2019.07.041

Cited by 23 publications

(17 citation statements)

References 35 publications

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“…Furthermore, patients operated for an AAA are usually older than patients operated for other aortoiliac vascular diseases. [ 4 , 6 , 9 ] In our study, the mean age was 70.1±10.1 in the AOD group and 68.7±9.6 in the AAA group, indicating no statistically significant difference. Some authors have noted a risk factor for male sex incisional hernia.…”

Section: Discussionmentioning

confidence: 46%

“…[ 14 ] However, some studies have reported no significant difference between the incision type and hernia. [ 6 , 15 ] According to a recent systematic review, five studies compared transverse with midline incisions in a total of 3,399 patients (2,098 with transverse and 1,301 midline incisions). [ 6 ] There was a trend toward a benefit of transverse incisions, but the results were not significant (p=0.08).…”

Section: Discussionmentioning

confidence: 99%

“…[ 6 , 15 ] According to a recent systematic review, five studies compared transverse with midline incisions in a total of 3,399 patients (2,098 with transverse and 1,301 midline incisions). [ 6 ] There was a trend toward a benefit of transverse incisions, but the results were not significant (p=0.08). This variable could not be compared in our study, since all patients were operated with a midline incision.…”

Section: Discussionmentioning

confidence: 99%

“…Incisional hernia is a well-known complication of abdominal surgery, occurring in 2 to 37% of patients. [ 1 - 6 ] Many previous studies have shown that the prevalence and incidence of incisional hernia are higher in patients having an abdominal aortic aneurysm (AAA) operation than patients undergoing aortoiliac occlusive disease (AOD). [ 1 - 3 ] One of the hypotheses regarding this condition is that the pathogenesis of both aortic aneurysm and incisional hernia development may be related to connective tissue metabolism disorder.…”

Section: Introductionmentioning

confidence: 99%

“…This pathogenesis has not been elucidated, yet. [ 6 , 7 ] In some small-scale studies, there is no significant difference between AAA and AOD in terms of incisional hernia development. [ 4 , 5 ]…”

Section: Introductionmentioning

confidence: 99%

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Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery

Sayur¹,

Güler²,

Posacıoğlu³

et al. 2021

Turk Gogus Kalp Dama

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Background: This study aims to investigate incisional hernia incidence and risk factors after abdominal aortic aneurysm and aortic occlusive disease surgery via a midline laparotomy. Methods: A total of 110 patients (66 males, 44 females; mean age: 69.3±8.8 years; range, 36 to 88 years) who underwent open elective surgery for aortoiliac occlusive diseases or abdominal aortic aneurysm between January 2005 and December 2016 were retrospectively analyzed. Both patient groups were compared in terms of surgical procedures, sex, age, American Society o f A nesthesiologists s core ( 1-3), b ody m ass i ndex (<25 vs. ≥25 kg/m2), smoking (non-smoker <1 pack/day, smoking ≥1 pack/day), and time to incisional hernia development. Results: Incisional hernia occurred in 14.3% of the patients operated for aortoiliac occlusive disease and in 17.6% of the patients operated for abdominal aortic aneurysm (p=0.643). Incisional hernia was seen in three (5.7%) of 53 patients with a body mass index of <25 kg/m2 and was in 15 (26.3%) of 57 patients with a body mass index of ≥25 kg/m2 (p=0.03). Conclusion: High body mass index is a risk factor for incisional hernia in patients undergoing aortic reconstructive surgery.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery

Sayur¹,

Güler²,

Posacıoğlu³

et al. 2021

Turk Gogus Kalp Dama

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Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review

García-Ureña

Berrevoet²,

Cuccurullo³

et al. 2021

Hernia

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Purpose Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable morbidity and expenses. In this critical review, the issue is explored by an interdisciplinary group. Methods A group of European surgeons encompassing representatives from abdominal wall, vascular, urological, gynecological, colorectal and hepato-pancreatico-biliarysurgery have reviewed the occurrence of His in these disciplines. Results Incisional hernias are a major public health issue with appreciable morbidity and cost implications. General surgeons are commonly called upon to repair IHs following an initial operation by others. Measures that may collectively reduce the frequency of IH across specialities include better planning and preparation (e.g. a fit patient, no time pressure, an experienced operator). A minimally invasive technique should be employed where appropriate. Our main recommendations in midline incisions include using the 'small bites' suture technique with a ≥ 4:1 suture-to-wound length, and adding prophylactic mesh augmentation in patients more likely to suffer herniation. For off-midline incisions, more research of this problem is essential. Conclusion Meticulous closure of the incision is significant for every patient. Raising awareness of the His is necessary in all surgical disciplines that work withing the abdomen or retroperitoneum. Across all specialties, surgeons should aim for a < 10% IH rate.

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The effect of prophylactic mesh implantation on the development of incisional hernias in patients with elevated BMI: a systematic review and meta-analysis

Pianka

Werba

Klotz

et al. 2022

Hernia

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Background Incisional hernia is a common complication after midline laparotomy. In certain risk profiles incidences can reach up to 70%. Large RCTs showed a positive effect of prophylactic mesh reinforcement (PMR) in high-risk populations. Objectives The aim was to evaluate the effect of prophylactic mesh reinforcement on incisional hernia reduction in obese patients after midline laparotomies. Methods Following the PRISMA guidelines, a systematic literature search in Medline, Web of Science and CENTRAL was conducted. RCTs investigating PMR in patients with a BMI ≥ 27 reporting incisional hernia as primary outcome were included. Study quality was assessed using the Cochrane risk-of-bias tool and certainty of evidence was rated according to the GRADE Working Group grading of evidence. A random-effects model was used for the meta-analysis. Secondary outcomes included postoperative complications. Results Out of 2298 articles found by a systematic literature search, five RCTs with 1136 patients were included. There was no significant difference in the incidence of incisional hernia when comparing PMR with primary suture (odds ratio (OR) 0.59, 95% CI 0.34–1.01, p = 0.06, GRADE: low). Meta-analyses of seroma formation (OR 1.62, 95% CI 0.72–3.65; p = 0.24, GRADE: low) and surgical site infections (OR 1.52, 95% CI 0.72–3.22, p = 0.28, GRADE: moderate) showed no significant differences as well as subgroup analyses for BMI ≥ 40 and length of stay. Conclusions We did not observe a significant reduction of the incidence of incisional hernia with prophylactic mesh reinforcement used in patients with elevated BMI. These results stand in contrast to the current recommendation for hernia prevention in obese patients.

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Abdominal Closure and the Risk of Incisional Hernia in Aneurysm Surgery – A Systematic Review and Meta-analysis

Cited by 23 publications

References 35 publications

Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery

Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery

Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review

The effect of prophylactic mesh implantation on the development of incisional hernias in patients with elevated BMI: a systematic review and meta-analysis

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