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Deerenberg E, et al., Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia.
These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions.
J. A. Pereira‑Rodríguez et al., Department of General and Digestive Surgery, Hospital, Universitario del Mar. Parc de Salut Mar, Barcelona, Spain
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.
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.
Prevention of Incisional Hernias by Prophylactic Meshaugmented Reinforcement of Midline Laparotomies for Abdominal Aortic Aneurysm Treatment3
Five-year Follow-up of a Randomized Controlled Trial
Maxime Dewulf MD, et al., Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
The incidence of incisional hernias (IHs) after open repair of an abdominal aortic aneurysm (AAA) is high. Several randomized controlled trials have reported favorable results with the use of prophylactic mesh to prevent IHs, without increasing complications. In this analysis, we report on the results of the 60-month follow-up of the PRIMAAT trial.
Prophylactic retrorectus mesh reinforcement after midline laparotomy for the treatment of AAAs safely and effectively decreases the rate of IHs. The cumulative incidence of IHs after open AAA repair, when no mesh is used, continues to increase during the first 5 years after surgery, which leads to a substantial rate of hernia repairs.
F. Pizza, et al., Department of Surgery, Hospital ‘Rizzoli’, Naples, Italy
Incisional hernia is a frequent postoperative complication after midline laparotomy. Prophylactic mesh augmentation in abdominal wall closure after elective surgery is recommended, but its role in emergency surgery is less well defined.
Prophylactic mesh-augmented abdominal wall closure after urgent laparotomy in clean-contaminated wounds is safe and effective in reducing the incidence of incisional hernia. Registration number: NCT04436887 (http://www.clinicaltrials.gov).
M. A. Garcia‑Urena, et al., Hospital Universitario del Henares, Faculty of Health Sciences. Universidad Francisco de Vitoria, Madrid, Spain
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.
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.
Benoit Gignoux, et al., Clinique de la Sauvegarde, Lyon, France
The aim of this work was to determine the rate of incisional hernia (IH) repair and risk factors for IH repair after laparotomy.
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.
R. Bittner, et al., Emeritus Director Marienhospital Stuttgart, Germany
A prophylactic mesh should be placed at the primary stoma operation
Prophylactic onlay mesh reinforcement has the potential to become the standard treatment for high-risk patients undergoing midline laparotomy
“..prophylactic mesh placement reduces the rate of incisional hernia in high-risk groups with morbid obesity or aortic aneurysm, or colorectal surgery"
Anders Wanhaineny, et al., Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden
“A recent meta-analysis based on several RCTs showed that prophylactic use of mesh reinforcement of midline laparotomies significantly reduces the risk of incisional hernia after open AAA repair.”
In patients treated for abdominal aortic aneurysm by open repair, prophylactic use of mesh reinforcement of midline laparotomies may be considered for patients at high risk of incisional hernia.
Hobart W. Harris, et al., Department of Surgery, University of California, San Francisco, USA
Incisional hernia is a frequent complication of midline laparotomy and enterostomal creation and is as- sociated with high morbidity, decreased quality of life, and high costs. The International Symposium on Incisional Hernia Prevention was held October 19 –20, 2017, at the InterContinental Hotel in San Francisco, CA, hosted by the Department of Surgery, University of California, San Francisco.
The Symposium was a combination of new information but also a comprehensive review of the existing data so as to assess the current state of the field and to set the stage for future research. Further, the Symposium sought to increase awareness and thus emphasize the importance of preventing the formation of incisional and enterostomal hernias.
F. E. Muysoms, et al., Department of Surgery, AZ Maria Middelares, Ghent, Belgium
“Prophylactic mesh augmentation appears effective and safe and can be suggested in high-risk patients, like aortic aneurysm surgery and obese patients.”
Prophylactic mesh augmentation for an elective midline laparotomy in a high-risk patient in order to reduce the risk of incisional hernia is suggested.