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Medtronic / Clinical Solutions / Incisional Hernia - Reinforce and Prevent

Discover our solutions to minimize incisional hernias

Reinforce and protect

Incisional hernias are preventable

Incisional hernias are the most common types of complications following laparotomy.
Incisional hernias are preventable
20 - 69%

High Incisional Hernia (IH) incidence rate1,2,3,4,5,6

Incisional hernias are preventable
6'451€

Average cost per Incisional Ventral Hernia Repair (IVHR)

Cost of IVHR in severe cases ~$16K7

When to use prophylactic mesh

The guidelines recommend prophylactic mesh placement in patients with a high risk of developing incisional hernia.8
Expected outcomes for an optimal repair9,10,11
Limited scarring
Comfort and durability
Quick integration

Refer to the current clinical evidence, recommendations and guidelines about Incisional Hernia prevention.

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Definition of ventral hernia by EURAHS12

Ventral Hernia is a clinically defined condition that

  • Developed after surgical trauma to the abdominal wall, including recurrences after repair of primary ventral hernias.
  • Also potentially resulting from an abdominal wall dehiscence, either complete or incomplete within 30 days after surgery.
  • Or during the placment of a colostomy, ileostomy or leal conduit stoma through the abdominal wall.

Which patients are most at risk?

Five common risk factors for incisional hernia development

What does the literature 1,13-42 say

  • Most procedure specific
  • Some standard for all procedure
The 5 key risk factors independent of procedure are:
 

Groups at increased risk of developing incisional hernias.19

Prevention of incisional hernia

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:

Abdominal Wall Closure

Literature8,44,45 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.

Mesh Reinforcement

Clinical evidence8,25 appears to show 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.

View the guide

Prophylactic mesh* placement is an important strategy in reducing the risk of incisional hernia formation in highrisk patients.8,25,46 

* Prophylactic mesh is part of the solution offered by Medtronic

How to position a prophylactic mesh

What is the ideal mesh to prevent incisional hernia?

Porosity9-11,47,48 

Limited scarring

Compliance9

Patient comfort

Compatible9,10

Quick integration

Durability9

Consistent, proven and strong

Progrip™ prophylactic mesh augmentation

The ProGrip™ Self-Gripping Polyester Mesh incorporates many of these attributes into one mesh.

Find more information on how the ProGrip™ Self-Gripping Polyester Mesh Technology can support your efforts to reinforce your laparotomies.

Visit product page

Get in touch with us to learn more about the ideal mesh to prevent incisional hernias

Get your trial
References:

 
  1. 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
  2. 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
  3. 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)
  4. 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
  5. Cingi A, Tebessum C, et al. Enterostomy Site Hernias: A Clinical and Computerized Tomography Evaluation. Dis Colon Rectum 2006; 49: 1559-1563
  6. Baucom RB, Ousley J, et al. Cancer Survivorship: Defining the Incidence of Incisional Hernia After Resection for Intra-Abdominal Malignancy
  7. 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
  8. 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
  9. Lefranc O, Bayon Y, Montanari S, Gravagna P, Thérin M. Reinforcement materials in soft tissue repair: Key parameters controlling tolerance and performance – current and future trends in mesh development, new techniques in genital prolapse surgery. Springer London. 2011; 275–287.
  10. Weyhe D, Cobb W, Lecuivre J, et al. Large pore size and controlled mesh elongation are relevant predictors for mesh integration quality and low shrinkage: systematic analysis of key parameters of meshes in a novel minipig hernia model. Int J Surg. 2015;22:46–53.
  11. Lake SP, Ray S, Zihni AM, Thompson DM Jr, Gluckstein J, Deeken CR. Pore size and pore shape – but not mesh density – alter the mechanical strength of tissue ingrowth and host tissue response to synthetic mesh materials in a porcine model of ventral hernia repair. J Mech Behav Biomed Mater. 2015;42:186–197.
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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
  26. 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
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  28. 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.
  29. 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
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  32. 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
  33. Oriel BS, Chen Q, Itani KMF. Incidence, recurrence and risk factors of hernias following stoma reversal. Am J Surg 214 (2017) 232-238
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  39. 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
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  41. 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
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  46. Rhemtulla IA et al. Role of Prophylactic Mesh Placement for Laparotomy and Stoma Creation Surg Clin N Am 2018; 98: 471–481.
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