Incisional hernias are the most common types of complications following laparotomy.
laparotomies in Western Europe per year
High Incisional Hernia (IH) incidence rate
Average cost per Incisional Ventral Hernia Repair (IVHR)
Cost of IVHR in severe cases ~16K€9
average yearly cost to Health Care System in Western Europe
The 5 key risk factors independent of procedure are:
The above defined biological and external factors may serve as selection parameters for the identification of high-risk patients potentially suitable for incisonal hernia prevention care.
The prophylactic care approach is build upon two pillars, as suggested by current literature:
Literature43,44,46 recommends to perform the abdominal wall closure, in a single layer aponeurotic closure technique, using the Small Bite Technique (SL/WL ratio > 4/1) with a Slowly-Absorbable Monofilament Suture.
Clinical evidence44,45 proves the safety & effectiveness of prophylactic synthetic mesh augmentation in onlay position following abdominal wall closure for the prevention of incisional hernia occurence in high risk patients.
Find more information on how the ProGrip™ Self-Gripping Polyester Mesh Technology can support your efforts to reinforce your laparotomies.
1. Brindley Eads B et al. Ventral Hernia Following Abdominal Section. Annals of Surgery Vol. XXXIII, No. 1, 1901.
2. Data Available at Medtronic internally
3. Alnassar S, Bawahab M, Abdoh A, et al. Incisional hernia postrepair of abdominal aortic occlusive and aneurysmal disease: five-year incidence. Vascular, Bol. 2012;20 No. 5:273-277. DOI: 10.1258/vasc.2011.oa0332
4. Antoniou SA, Agresta F, Garcia Alamino JM, et al. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 2018;22:183-198. https://doi.org/10.1007/s10029-017-1697-5
5. Aquina CHT, Rickles AS, Probst P, et al. Visceral Obesity, Not Elevated BMI, Is Strongly Associated With Incisional Hernia After Colorectal Surgery. Diseases of Colon & Rectum Vol 58:3 (2015)
6. Van Ramshorst GH, Eker HH, Hop WCJ, et al. Impact of incisional hernia on health-related quality of life and body image: a perspective cohort study. Am J Surg (2012) 204:144-150
7. Cingi A, Tebessum C, et al. Enterostomy Site Hernias: A Clinical and Computerized Tomography Evaluation. Dis Colon Rectum 2006; 49: 1559-1563
8. Baucom RB, Ousley J, et al. Cancer Survivorship: Defining the Incidence of Incisional Hernia After Resection for Intra-Abdominal Malignancy
9. Gillion JF, Sanders D, Miserez M et al. The economic burden of incisional ventral hernia repair: a multicentric cost analysis. Hernia 2016;20:819-830
10. Muysoms F, Campanelli G, Champault GG, et al. EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia (2012) 16:239-250
11. Abo-Ryia MH., El-Khadrawy OH., Abd-Allah HS. Prophylactic Preperitoneal Mesh Placement in Open Bariatric Surgery: a Guard Against Incisional Hernia Development. Obes Surg (2013) 23:1571-1574. DOI 10.1007/s11695-013-0915-1
12. Alnassar S, Bawahab M, Abdoh A, et al. Incisional hernia postrepair of abdominal aortic occlusive and aneurysmal disease: five-year incidence. Vascular, Bol. 2012;20 No. 5:273-277. DOI: 10.1258/vasc.2011.oa0332
13. Bewö K, Österberg J, Löfgren M, et al. Incisional hernias following open gynecological surgery: a population-based study. Arch Gynecol Obstet (2019) 299:1313-1319
14. Blazquez Hernando LA, Garcıa-Urena MA, Lopez-Monclus J, et al. Prophylactic mesh can be used safely in the prevention of incisional hernia after bilateral subcostal laparotomies. Surgery 2016;160:1358-1366. http://dx.doi.org/10.1016/j.surg.2016.05.010
15. Borab ZM, Shakir S, Lanni MA et al. Does prophylactic mesh placement in elective, midline laparotomy reduce the incidence of incisional hernia? A systematic review and meta-analysis. Surgery 2017;161:1149–1163. doi:10.1016/j.surg.2016.09.036
16. Fischer JP, Basta MN, Mirzabeigi MN et al. A risk model and cost analysis of incisional hernia after elective, abdominal surgery based upon 12,373 cases. Ann Surg 2016;263:1010–1017. doi:10.1097/SLA.0000000000001394
17. Garcia-Urena MA, Lopez-Monclus J, Blazquez Hernando LA, et al. Randomized Controlled Trial of the Use of a Large-pore Polypropylene Mesh to Prevent Incisional Hernia in Colorectal Surgery. Ann Surg 2015;261:876-881. DOI: 10.1097/SLA.0000000000001116
18. Gignoux B, Blanc P, Martin D, et al. Incisional hernia prophylaxis: Retrospective assessment of population risk, frequency, complications, and cost in a large population. ESCP 2019
19. Guitarte C, Grant J, Zhao H, et al. Incisional hernia formation and associate4d risk factors on a gynecologic oncology service: an exploratory analysis. Arch Gynecol Obstet (2016) 294:805-811
20. Harris HW, Hope WH, Adrales G, et al. Contemporary concepts in hernia prevention: Selected proceedings from the 2017 International Symposium on Prevention of Incisional Hernias, Surgery 2018;000:1-8. https://doi.org/10.1007/s10151-018-1774-5
21. Heimann TM, Swaminathan S, Greenstein AJ, et al. Incidence and Factors Correlating With Incisional Hernia Following Open Bowel Resection in Patients With Inflammatory Bowel Disease. A Review of 1000 Patients. Ann Surg 2018;267:532-536
22. Hidalgo MP, Ferrero EH, Ortiz MA. Incisional hernia in patients at risk: can it be prevented? Hernia 2011;15:371-375. DOI 10.1007/s10029-011-0794-0
23. Indrakusuma R, Jalalzadeh H, van der Meij JE, et al. Prophylactic Mesh Reinforcement versus Suture Closure to Prevent Incisional Hernias after Open Abdominal Aortic Aneurysm Repair via Midline Laparotomy: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2018;56:120-128. https://doi.org/10.1016/j.ejvs.2018.03.021
24. Jairam AP, Timmermans L, Eker HH, et al. 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 2017;390:567-76. http://dx.doi.org/10.1016/ S0140-6736(17)31332-6
25. Kaneko T, Funahashi K, Ushigome M, et al. Incidence of and risk factors for incisional hernia after closure of temporary ileostomy for colorectal malignancy. Hernia (2019) 23:743-748
26. Lanni MA, Tecce MG, Shubinets V, et al. The State of Prophylactic Mesh Augmentation, Am Surg 2018;84:99-108. ISSN: 1555-9823
27. Llaguna OH, Avgerinos DV, Nagda P, Elfant D, et al. Does prophylactic biologic mesh placement protect against the development of incisional hernia in high-risk patients? World J Surg 2011;35:1651-5.
28. Lorenz A, Kogler P, Kafka-Ritsch R, et al. Incisional hernia at the site of stoma reversal - incidence and risk factors in a retrospective observational analysis. Int J Colorectal Dis (2019) 34:1179-1187
29. Moulton L, Jernigan AM, Carr C, et al. Single-port laparoscopy in gynecologic oncology: seven years of exerience at a single institution. Am J Obstet Gynecol 2017;217:610.e1-8
30. Muysoms FE, Dietz UA. Prophylactic meshes in the abdominal wall. Chirurg 2017;88[Suppl 1]:S34-S41. DOI 10.1007/s00104-016-0229-7
31. Ooms LS, Verhelst J, Jeekle J, et al. Incidence, risk factors, and treatment of incisional hernia after kidney transplantation: An analysis of 1,564 consecutive patients. Surgery 2016;159:1407-11
32. Oriel BS, Chen Q, Itani KMF. Incidence, recurrence and risk factors of hernias following stoma reversal. Am J Surg 214 (2017) 232-238
33. Pans A, Elen P, Dewé W, et al. Long-term Results of Polyglactin Mesh for the Prevention of Incisional Hernias in Obese Patients. World J. Surg. (1988) 22:479-483
34. Rhemtulla IA, Mauch JT, Broach RB, et al. Prophylactic mesh augmentation: Patient selection, techniques, and early outcomes, Am J Surg 2018;xxx:1-6. https://doi.org/10.1016/j.amjsurg.2018.04.008
35. San Miguel C, Melero D, Garcia-Urena MA, et al. Long-term outcomes after prophylactic useof onlay mesh in midline laparotomy. Hernia. Published online: 04. October 2018, https://doi.org/10.1007/s10029-018-1833-x
36. Sarr MG, Hutcher NE, Snyder S, et al. A prospective, randomized, mulitcenter trial of Surgisis Gold, a biologic prosthetic, as a sublay reinforcement of the fascial closure after open bariatirc surgery. J Surg 2014;156:4:902-909
37. Söderbäck H, Gunnarsson U, Hellmann P, et al. Incisional hernia after surgery for colorectal cancer: a population-based register study. Int J Colorectal Dis 2018;33:1411-1417. https://doi.org/10.1007/s00384-018-3124-5
38. Spencer RJ, Hayes KD, Rose S, et al. Risk Factors for Early-Occuring and Late-Occuring Incisional Hernias After Primary Laparotomy for Ovarian Cancer. Obstet Gynecol 2015; 125:407-13
39. Tecce MG, Basta MN, Shubinets V, et al. A risk model and cost analysis of post-operative incisional hernia following 2,145 open hysterectomies – Defining indications and opportunities for risk reduction. Am J Surg 2017;213:1083-1090. http://dx.doi.org/10.1016/j.amjsurg.2016.09.047
40. Ulukent SC, Ozyurek ES, Sarici IS, et al. Risk factors for incisional hernia in gyecological cancer patients. Int J Clin Exp Med 2016;9(8):16468-16475
41. Van den Hill LCL, Van Steensel S, Schreinemacher MHF, et al. Prophylactic mesh placement to avoid incisional hernias after stoma reversal: a systematic review and meta-analysis. Hernia (2019) 23: 733-741
42. Wang XC, Zhang D, Yang ZX, et al. Mesh reinforcement for the prevention of incisional hernia formation: a systematic review and meta-analysis of randomized controlled trials. J Surg Res 2017;209:17–29. doi:10.1016/j.jss.2016.09.055
43. Deerenberg EB, Harlaar JJ, Steyerberg EW, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 2015;386:1254-60
44. Muysoms FE, Antoniou SA, Bury K, et al. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 2015;19:1–24. DOI 10.1007/s10029-014-1342
45. Jairam AP, Timmermans L, Eker HH, et al. 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 2017;390:567-76. http://dx.doi.org/10.1016/ S0140-6736(17)31332-6
46. Millbourn D, Cengiz Y, Isrealsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg (2009) 144:1056-1059