Top

Published in:

Open Access 01-04-2022 | Laparotomy | Original Article

Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool

Authors: J. A. Pereira-Rodríguez, S. Amador-Gil, A. Bravo-Salva, B. Montcusí-Ventura, J. Sancho-Insenser, M. Pera-Román, M. López-Cano

Published in: Hernia | Issue 2/2022

Abstract

Purpose

The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes.

Methods

Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB.

Results

A lower number of FD appeared in the M group (OR 0.0692; 95% CI 0.008–0.56; P = 0.01) in 197 operations. After a mean follow-up of 29.23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0.769; 95% CI 0.65–0.91; P < 0.0001). (33) The observed differences persisted after a propensity matching score: FD (OR 0.355; 95% CI 0.255–0.494; P < 0.0001) and IH (OR 0.394; 95% CI 0.24–0.61; P < 0.0001). On comparing suturing techniques by subgroups, both mesh subgroups had better outcomes. PM was the main factor related to the reduction of IH (HR 11.794; 95% CI 4.29–32.39; P < 0.0001).

Conclusion

Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used.

Jenkins TP (1976) The burst abdominal wound: a mechanical approach. Br J Surg 63(11):873–876. https://doi.org/10.1002/bjs.1800631110CrossRefPubMed

Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D et al (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19(1):1–24CrossRefPubMed

Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J et al (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386(10000):1254–1260CrossRefPubMed

Millbourn D, Cengiz Y, Israelsson LA (2009) Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 144(11):1056–1059. https://doi.org/10.1001/archsurg.2009.189CrossRefPubMed

Jairam AP, Timmermans L, Eker HH, Pierik REGJM, van Klaveren D, Steyerberg EW, Timman R, van der Ham AC, Dawson I, Charbon JA, Schuhmacher C, Mihaljevic A, Izbicki JR, Fikatas P, Knebel P, Fortelny RH, Kleinrensink GJ, Lange JF, Jeekel HJ, PRIMA Trialist Group (2017) Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet 390(10094):567–576CrossRefPubMed

Borab ZM, Shakir S, Lanni MA et al (2017) Does prophylactic mesh placement in elective, midline laparotomy reduce the incidence of incisional hernia? A systematic review and meta-analysis. Surgery 161(4):1149–1163. https://doi.org/10.1016/j.surg.2016.09.036CrossRefPubMed

García-Ureña MÁ, López-Monclús J, Hernando LA et al (2015) Randomized controlled trial of the use of a large-pore polypropylene mesh to prevent incisional hernia in colorectal surgery. Ann Surg 261(5):876–881. https://doi.org/10.1097/SLA.0000000000001116CrossRefPubMed

Yheulon C, Davis SS Jr (2019) Adopting the STITCH Trial: crossing the chasm from publication to practice. JAMA Surg 154(12):1087–1088. https://doi.org/10.1001/jamasurg.2019.3358CrossRefPubMed

Bloemen A, De Kleijn RJCMF, Van Steensel S, Aarts F, Schreinemacher MHF, Bouvy ND (2019) Laparotomy closure techniques: Do surgeons follow the latest guidelines? Results of a questionnaire. Int J Surg 71:110–116. https://doi.org/10.1016/j.ijsu.2019.09.024CrossRefPubMed

10.

Fischer JP, Harris HW, López-Cano M, Hope WW (2019) Hernia prevention: practice patterns and surgeons’ attitudes about abdominal wall closure and the use of prophylactic mesh. Hernia 23(2):329–334. https://doi.org/10.1007/s10029-019-01894-zCrossRefPubMed

11.

Pereira Rodríguez JA, Amador-Gil S, Bravo-Salva A et al (2021) Small bites technique for midline laparotomy closure: from theory to practice: Still a long way to go. Surgery 170:140–145. https://doi.org/10.1016/j.surg.2020.12.007CrossRefPubMed

12.

Itatsu K, Yokoyama Y, Sugawara G, Kubota H et al (2014) Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 101(11):1439–1447CrossRefPubMed

13.

Sørensen LT, Kallehave F, Wille-Jørgensen P, Kjærgaard J, Nørgaard L, Jørgensen T (2005) Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg 241:654–658CrossRefPubMedPubMedCentral

14.

Van Ramshorst GH, Nieuwenhuizen J, Hop WCJ et al (2010) Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 34:20. https://doi.org/10.1007/s00268-009-0277-yCrossRefPubMed

15.

Surgical Site Infection (SSI) Event: Center for Disease Control. 2010. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf?agree=yes&next=Accept. Updated January 2021. Accessed March 28, 2021

16.

Dindo D, Demartines NCP (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

17.

Kroese LF, Sneiders D, Kleinrensink GJ, Muysoms F, Lange JF (2018) Comparing different modalities for the diagnosis of incisional hernia: a systematic review. Hernia 22(2):229–242. https://doi.org/10.1007/s10029-017-1725-5CrossRefPubMedPubMedCentral

18.

Jairam AP, Timmermans L, Eker HH et al (2017) Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet 390(10094):567–576. https://doi.org/10.1016/S0140-6736(17)31332-6 ([published correction appears in Lancet. 2017 Aug 5;390(10094):554])CrossRefPubMed

19.

Caro-Tarrago A, Olona Casas C, Jimenez Salido A, Duque Guilera E, Moreno Fernandez F, Vicente Guillen V (2014) Prevention of incisional hernia in midline laparotomy with an onlay mesh: a randomized clinical trial. World J Surg 38(9):2223–2230. https://doi.org/10.1007/s00268-014-2510-6CrossRefPubMed

20.

Muysoms FE, Detry O, Vierendeels T et al (2016) Prevention of incisional hernias by prophylactic mesh-augmented reinforcement of midline laparotomies for abdominal aortic aneurysm treatment: a randomized controlled trial. Ann Surg 263(4):638–645. https://doi.org/10.1097/SLA.0000000000001369CrossRefPubMed

21.

Denys A, Monbailliu T, Allaeys M, Berrevoet F, van Ramshorst GH (2021) Management of abdominal wound dehiscence: update of the literature and meta-analysis. Hernia 25(2):449–462. https://doi.org/10.1007/s10029-020-02294-4CrossRefPubMed

22.

López-Cano M, García-Alamino JM, Antoniou SA et al (2018) EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen. Hernia 22(6):921–939. https://doi.org/10.1007/s10029-018-1818-9CrossRefPubMed

23.

López-Cano M, Pereira JA, Armengol-Carrasco M (2013) “Acute postoperative open abdominal wall”: Nosological concept and treatment implications. World J Gastrointest Surg 5(12):314–320. https://doi.org/10.4240/wjgs.v5.i12.314CrossRefPubMedPubMedCentral

24.

Lima HVG, Rasslan R, Novo FCF et al (2020) Prevention of fascial dehiscence with onlay prophylactic mesh in emergency laparotomy: a randomized clinical trial. J Am Coll Surg 230(1):76–87. https://doi.org/10.1016/j.jamcollsurg.2019.09.010CrossRefPubMed

25.

de Vries HS, Verhaak T, van Boxtel TH et al (2020) Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections. Hernia 24(4):839–843. https://doi.org/10.1007/s10029-019-01995-9CrossRefPubMed

26.

Ihedioha U (2008) Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc 22:689–692CrossRefPubMed

27.

Goodenough CJ, Ko TC, Kao LS et al (2015) Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project). J Am Coll Surg 220(4):405–413CrossRefPubMedPubMedCentral

28.

Lee L, Mappin-Kasirer B, Sender Liberman A, Stein B, Charlebois P, Vassiliou M, Fried GM, Feldman LS (2012) High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection. Surg Endosc 26(11):3180–3185CrossRefPubMed

29.

Pereira JA, Pera M, López-Cano M et al (2019) Hernias at the extraction incision after laparoscopic colon and rectal resection: influence of incision location and use of prophylactic mesh. Cir Esp 97(1):20–26. https://doi.org/10.1016/j.ciresp.2018.08.002CrossRefPubMed

Title: Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool
Authors: J. A. Pereira-Rodríguez
S. Amador-Gil
A. Bravo-Salva
B. Montcusí-Ventura
J. Sancho-Insenser
M. Pera-Román
M. López-Cano
Publication date: 01-04-2022
Publisher: Springer Paris
Keywords: Laparotomy
Laparotomy
Incisional Hernia
Published in: Hernia / Issue 2/2022
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-021-02527-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2022

Comment to: “Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)”

Comment to: feasibility of modified-TEP technique for large inguinoscrotal and large femoral hernia and its advantages. Author’s reply

Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging

Intraperitoneal versus extraperitoneal mesh in minimally invasive ventral hernia repair: a systematic review and meta-analysis

Anarchy in abdominal wall surgery: a serious ethical and socio-economical issue. LAST CALL!

It’s time to re-acknowledge the differences: author’s reply