Prevention of Incisional Hernias after Open Abdomen Treatment

Abstract

Management of a patient with an open abdomen is difficult, and the primary closure of the fascial edges is essential to obtain the best patient outcome, regardless of the initial etiology of the open abdomen. The use of temporary abdominal closure devices is nowadays the gold standard to have the highest closure rates with mesh-mediated fascial traction as the proposed standard of care. However, the incidence of incisional hernias, although much more controlled than when leaving an abdomen open, is high and reaches up to 65%. As shown for other high-risk patient subgroups, such as obese patients, patients with an abdominal aneurysm, and patients with former -ostomy sites, the prevention of incisional hernias might be key to further optimize patient outcomes after open abdomen treatment. In this overview, current available modalities to decrease the incidence of incisional hernia are discussed. Most of these preventive options have been shown effective in giant ventral hernia repair and might work effectively in this patient cohort with open abdomen as well.

Prophylactic Onlay Mesh Implantation During Definitive Fascial Closure After Open Abdomen Therapy (PROMOAT): Absorbable or Non-absorbable? Methodical Description and Results of a Feasibility Study

“…These results were recently confirmed for emergency laparotomies, as well (16). Put these findings together; it seems reasonable to suppose that the fascial closure after OAT is a similar high-risk situation, both in terms of patient-specific or surgical-technical factors (11).…”

“…This will likely be reflected in upcoming updates of guidelines on abdominal surgery. However, small bites technique, a suture length to wound length ratio of >4:1 with a long-term or nonabsorbable running suture is still the current state of the art of abdominal wall closure following the European Hernia Society guidelines of the abdominal wall closure (9,11,17).…”

“…Little is published on the specific aspects of incisional hernia development after OAT; however some monocentric retrospective studies showed the incisional hernia incidence after OAT to be far higher (35-66%) than after regular laparotomies (5)(6)(7)(8)(9). The development of incisional hernias depends on various factors such as surgical technique (e.g., incision type, suture technique, and material) or comorbidity (i.e., aortic aneurysm, obesity) (10,11).…”

“…The most relevant factor associated with the surgical procedure itself is the actual technique of how fascial closure is obtained. The European Hernia Society has given recommendations on fascial closure, which involve the use of long-term absorbable sutures and a suture length to wound length (SL:WL) ratio of at least 4:1 (9,11,17).…”

Early and Late Outcome After Suprasonic Excision of Infected Mesh Implants After Hernioplasty

“…Surgical infection that occurs after installing mesh implants in cases of ventral and inguinal hernia, is a serious problem that does not have a definite approach to its solution (1). The majority of authors believe that to eliminate this complication it is necessary to use all existing methods of conservative therapy (2).…”