Incisional Hernia Prevention and Use of Mesh. A Narrative Review

Hernández-Granados, Pilar; López-Cano, Manuel; Morales‐Conde, Salvador; Muysoms, Filip; García-Alamino, Josep M; Rodríguez, José Antonio Pereira

doi:10.1016/j.cireng.2018.01.010

Cited by 10 publications

(8 citation statements)

References 80 publications

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“…This recommendation may lead to an increasing use of SUL in the future, especially in emergency surgery in which the open approach is chosen more frequently than in elective surgery. Lateral incisional hernia has high recurrence rates after repair [6][7][8], and SL has been classified by a group of experts as complex hernia [9]. The EHS guidelines do not provide any recommendations for preventing IH in lateral approaches.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Incisional Hernia After Emergency Subcostal Unilateral Laparotomy: Does Augmentation Prophylaxis Play a Role?

et al. 2019

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Background Few data are available about the frequency of incisional hernia in an emergency subcostal laparotomy. Our objective is to analyze the incidence of incisional hernia after emergency subcostal laparotomy and evaluate if prophylactic mesh could help prevent it. Methods This study is a monocentric retrospective analysis following STROBE guideline statements of all patients who underwent an emergency subcostal laparotomy between January 2011 and July 2017 in our University Hospital. We compared complications and incidence of incisional hernia between patients who received sutures (Group S; N = 203) and patients with prophylactic onlay mesh (Group M; N = 80). A multivariate risk factor analysis of incisional hernia was performed. An incisional hernia-estimated risk calculator equation was created. Results A total of 283 patients were analyzed. There were 80 patients in Group M and 203 in Group S. In short-term outcomes, length of surgery (213 ± 115 min vs 165 ± 73.3 min, P = 0.001) and hospital stay (16.4 ± 18.7 vs 11.6 days ± 13.4, P = 0.038) were longer in Group M. Long-term follow-up was conducted in 207 patients with a mean follow-up time of 39.3 ± 23 months. Incisional hernia was detected in 29 (19.1%) patients in Group S but in only two (3.8%) patients in Group M (P = 0.008). In the multivariate analysis, a risk factor analysis included wound infection (4.91 HR (2.12-11.4); P \ 0.001), previous hernia repair (2.86 HR (1.24-6.61); P = 0.014), and shock (2.64 HR (1.01-6.93); P = 0.048). Conclusions The incidence of incisional hernia after emergency subcostal laparotomy is high. Risk factors are wound infection, shock, and previous hernia surgery. The use of prophylactic mesh augmentation was safe and reduced the incidence of incisional hernia.

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Section: Introductionmentioning

confidence: 99%

Incidence of Incisional Hernia After Emergency Subcostal Unilateral Laparotomy: Does Augmentation Prophylaxis Play a Role?

et al. 2019

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“…В первые сутки после операции достоверного различия не было. Так, у пациентов 1-й группы интенсивность болевого синдрома через 1 час после операции составила 2,5 (2-3,5) балла, у пациентов 2-й группы -3 (2,5-3,5) балла (р = 0,137), через 6 ч после операции у пациентов 1-й группы -2 (2-3) балла, у пациентов 2-й группы -2,5 (2,5) балла (р = 0,076), через 12 ч у пациентов 1-й группы -2 (1,5-2,5) балла, у пациентов 2-й группы -2 (1,5-3) балла (р = 0,069), через 24 ч у пациентов 1-й группы интенсивность болевого синдрома была достоверно ниже -1,5 (0,6-1,5), 2-й группы -2,5 (2-3) (р = 0,042). Соответственно, при отсутствии различия в интенсивности болевого синдрома в группах в первые сутки после операции не было выявлено достоверного различия во времени первого…”

Section: результаты и их обсуждениеunclassified

“…Лечение больных с грыжами передней брюшной стенки остается актуальной проблемой хирургии. Это обусловлено тем, что число послеоперационных грыж в структуре наружных грыж живота постоянно растет, достигая в настоящее время 20 % всех операций на органах брюшной полости [1,2]. Это связано с ростом числа травматичных и продолжительных операций в абдоминальной хирургии, в том числе этапных и повторных вмешательств, а также постоянным увеличением среди оперируемых лиц с сопутствующим ожирением.…”

Section: Introductionunclassified

Comparison of anesthesia and perioperative analgesia in simulty hernioplasty and abdominoplasty in patients with obesity

Неймарк

Киселев

2019

Annals of Critical Care

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Justification. Among patients with large postoperative ventral hernias, the most common are patients with varying degrees of obesity. This group of patients presents a certain complexity for anesthesia in connection with a number of anatomical and physiological changes and a high risk of complications in the early postoperative period in connection with which this study was conducted. Purpose of trial. Study of the influence of various anaesthetic management and perioperative analgesia with simultaneous hernioplasty and abdominoplasty of major postoperative incisional hernia (PIH) in patients with obesity during the perioperative period. Materials and methods. A randomized trial of 59 patients with a body mass index > 30 kg /m2 was performed. Depending on the type of anesthesia, patients are divided into two groups. In the 1st group (n = 30), the operation was performed on low-flow inhalation of desflurane based anaesthesia in combination with prolonged epidural analgesia (PEA) with ropivacaine, in the 2nd group (n = 29), the operation was performed on low flow inhalation of desflurane anesthesia based in combination with blockade of transverse abdominal plane (TAP) with 0.5% solution of ropivacaine. The indicators adequacy of anesthesia parameters investigated, central and peripheral hemodynamics were monitored neuromuscular conduction, evaluated the efficacy of recovery after surgery and postoperative analgesia quality, postoperative critical incident were studied. Results. It was found that surgical intervention in low-flow inhalation desflurane anaesthesia based combined with PEA ropivacaine promotes faster recovery after surgery and effective postoperative analgesia and fewer complications in the early postoperative period, which contributed to significantly shorter hospital lengths of stay for patients in group 1 - 82,5 hours (95% CI 76-93,5) compared with group 2 - 94 hours (95% CI 85,5-113) (p = 0,015). Conclusions. Combined desflurane-based anesthesia in combination with regional methods is an effective method of anesthesia and analgesia in the perioperative period and contributes to faster recovery after surgery and shorter surgical treatment with simultaneous hernio- and abdominoplasty of large (PIH) in obese patients.

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“…Therefore, at present, the options for reducing the incidence of this complication focus on the use of prophylactic meshes (2)(3)(6)(7)(8)(9)(10)(11) and on modifying the laparotomy closure technique. Evidence indicates that the use of prophylactic mesh is a safe and effective procedure in both clean and clean-contaminated surgery, but there is insu cient evidence for contaminated or dirty surgeries (12)(13)(14); nonetheless, its use has not yet become widespread.…”

Section: Introductionmentioning

confidence: 99%

Incisional Hernia Prevention By Modification of The Abdominal Wall Closure Technique: Systematic Review And Meta-analysis

Hernández

Bonilla

Ugarte

et al. 2021

Preprint

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Background: Incisional hernia (IH) is the main complication after laparotomy. The objective of this meta-analysis was to evaluate the effectiveness of closure technique modification (CTM) for reducing the incidence of IH to provide objective support for its recommendation.Methods: A meta-analysis was performed according to the PRISMA guidelines. The primary objective was to determine the incidence of IH, and the secondary objective was to determine the incidence of acute evisceration and postoperative complications. Only published clinical trials were included. The risk of bias was analyzed, and the random effects model was used to determine statistical significance.Results: Nine studies comparing 2,612 patients were inclued. The incidence of IH was significantly lower in the CTM group than in the control group, with an OR of 0.39 (95% CI 0.26-0.57). The incidence of acute postoperative evisceration was also reduced, with an OR of 0.46 (95% CI 0.23-0.92). Associated complications, including hematoma, seroma, and postoperative pain, could not be analyzed; however, CTM did not increase the risk of surgical site infection.Conclusion: CTM for midline laparotomy significantly reduces the incidence of IH compared to conventional closure. Limitations of the analysis included differences in follow-up, patient selection, diagnostic methods, and the reporting of postoperative complications among the studies.Funding Information: No funding was received.Registration: This study was prospectively registered in the PROSPERO database under registration number CRD42021231107.

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Incisional Hernia Prevention and Use of Mesh. A Narrative Review

Cited by 10 publications

References 80 publications

Incidence of Incisional Hernia After Emergency Subcostal Unilateral Laparotomy: Does Augmentation Prophylaxis Play a Role?

Incidence of Incisional Hernia After Emergency Subcostal Unilateral Laparotomy: Does Augmentation Prophylaxis Play a Role?

Comparison of anesthesia and perioperative analgesia in simulty hernioplasty and abdominoplasty in patients with obesity

Incisional Hernia Prevention By Modification of The Abdominal Wall Closure Technique: Systematic Review And Meta-analysis

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