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Terapias de mínima invasión / Soluciones Clínicas / Prevención de hernias incisionales

Prevención de las hernias incisionales

Las hernias incisionales son los tipos más comunes de complicaciones después de la laparotomía.

3,2 millones2

de laparotomías en Europa Occidental por año

20 - 80 %3,4,5,6,7,8

Tasa de incidencia alta de hernias incisionales (IH)

4.731 €9

Coste medio por reparación de hernia ventral incisional (IVHR)

Coste de la IVHR en casos graves: 16.000 €9 aproximadamente

3.000 millones € mín.

Coste medio anual del sistema sanitario en Europa occidental

Vea lo que dicen las distintas directrices sobre la profilaxis de hernias incisionales

Definición de hernia ventral incisional según EuraHS10

La hernia ventral incisional es una patología definida que

  • Se desarrolla después de un traumatismo quirúrgico en la pared abdominal, incluidas las recidivas después de la reparación de hernias ventrales primarias.
  • También puede ser el resultado de una dehiscencia de la pared abdominal, ya sea completa o incompleta, dentro de los 30 días posteriores a la cirugía.
  • O que surge durante la colocación de una colostomía, ileostomía o estoma del conducto leal a través de la pared abdominal.

Cinco factores de riesgo comunes para el desarrollo de una hernia incisional

la información que tenemos disponible hace referencia a11-42

  • Específica para la mayoría de los procedimientos
  • Algún estándar para todas las intervenciones

Los 5 factores de riesgo clave independientes de la intervención son:

Prevención de la hernia incisional

Los factores definidos anteriormente pueden servir como parámetros para indentificar pacientes con potencial de alto riesgo que son susceptibles al tratamiento preventivo de hernias incisionales.

Tal como sugiere la bibliografía actual, el tratamiento profiláctico se basa en dos pilares: 

Cierre de la pared abdominal

La bibliografía43,44,46 recomienda realizar el cierre de la pared abdominal, con una técnica de cierre aponeurótico de una sola capa, realizando una oclusión pequeña (relación entre la longitud de la sutura y la longitud de la herida > 4/1) con una sutura de monofilamento que se absorbe lentamente.

Refuerzo de malla

La evidencia clínica44,45 demuestra la efectividad y la seguridad por la colocación de la malla profiláctica sintética en posición onlay después del cierre de la pared abdominal. El objetivo es la prevención de la aparición de hernias incisionales en pacientes de alto riesgo. 

Ver guía

Malla profiláctica ProGrip™

Encuentre más información sobre cómo la tecnología de la malla de poliéster autoadhesiva ProGrip™ puede ayudarle a reforzar sus laparotomías.

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  • 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

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