Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis

Jairam, An P.; López-Cano, Manuel; Garcia-Alamino, J. M.; Pereira, J.A.; Timmermans, Lucas; Jeekel, J.; Lange, Johan F.; Muysoms, Filip

doi:10.1002/bjs5.50261

Cited by 45 publications

(38 citation statements)

References 35 publications

(65 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These authors recommended the use of surgical mesh in some high-risk patients and suggested that individual risk factors should be taken into account when selecting patients who would most benefit from mesh insertion. Another recent metaanalysis and sequential analysis of 12 RCTs involving 1815 patients by Jairam et al [34] reported that prophylactic mesh reinforcement using an onlay or retromuscular technique after midline abdominal surgery significantly decreased the rate of occurrence of IH in high-risk patients and that onlay mesh reinforcement could become the standard treatment for high-risk patients undergoing midline laparotomy.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for incisional hernia and recurrence: Retrospective analysis of the French national database

Gignoux¹,

Bayon

Martin

et al. 2021

Colorectal Disease

View full text Add to dashboard Cite

The aim of this work was to determine the rate of incisional hernia (IH) repair and risk factors for IH repair after laparotomy. Method: This population-based study used data extracted from the French Programme de Médicalisation des Systèmes d'Informations (PMSI) database. All patients who had undergone a laparotomy in 2010, their hospital visits from 2010 to 2015 and patients who underwent a first IH repair in 2013 were included. Previously identified risk factors included age, gender, high blood pressure (HBP), obesity, diabetes and chronic obstructive pulmonary disease (COPD).Results: Among the 431 619 patients who underwent a laparotomy in 2010, 5% underwent IH repair between 2010 and 2015. A high-risk list of the most frequent surgical procedures (>100) with a significant risk of IH repair (>10% at 5 years) was established and included 71 863 patients (17%; 65 procedures). The overall IH repair rate from this list was 17%. Gastrointestinal (GI) surgery represented 89% of procedures, with the majority of patients (72%) undergoing lower GI tract surgery. The IH repair rate was 56% at 1 year and 79% at 2 years. Risk factors for IH repair included obesity (31% vs 15% without obesity, p < 0.001), COPD (20% vs 16% without COPD), HBP (19% vs 15% without HBP) and diabetes (19% vs 16% without diabetes). Obesity was the main risk factor for recurrence after IH repair (19% vs 13%, p < 0.001). Conclusion:From the PMSI database, the real rate of IH repair after laparotomy was 5%, increasing to 17% after digestive surgery. Obesity was the main risk factor, with an IH repair rate of 31% after digestive surgery. Because of the important medico-economic consequences, prevention of IH after laparotomy in high-risk patients should be considered.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for incisional hernia and recurrence: Retrospective analysis of the French national database

Gignoux¹,

Bayon

Martin

et al. 2021

Colorectal Disease

View full text Add to dashboard Cite

show abstract

“…A recent systematic review concluded that mesh reinforcement is safe and effective at early-to-midterm assessment [73].…”

Section: Prophylactic Mesh Augmentation In Patients At Increased Riskmentioning

confidence: 99%

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

García-Ureña

Berrevoet²,

Cuccurullo³

et al. 2021

Hernia

View full text Add to dashboard Cite

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.

show abstract

“…The main complication after laparotomy is incisional hernia (IH), which has an incidence of 10-23% (1), although this can increase to up to 40% in speci c risk groups (2). IH is often asymptomatic; however, in some patients, it is a signi cant a cause of morbidity (pain), in addition to having a negative effect on the patient's quality of life and body image (3).…”

Section: Introductionmentioning

confidence: 99%

“…The actual impact of prehabilitation on the reduction of IH has not yet been determined, and in patients undergoing emergency surgery, prehabilitation is not possible. 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

View full text Add to dashboard Cite

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.

show abstract

Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis

Cited by 45 publications

References 35 publications

Incidence and risk factors for incisional hernia and recurrence: Retrospective analysis of the French national database

Incidence and risk factors for incisional hernia and recurrence: Retrospective analysis of the French national database

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

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

Contact Info

Product

Resources

About