The Use of an Algorithm for Prophylactic Mesh Use in High Risk Patients Reduces the Incidence of Incisional Hernia Following Laparotomy for Colorectal Cancer Resection

Abstract Aim According to the guidelines, prophylactic mesh placement appears to be an effective, safe procedure in high-risk patients for the prevention of incisional hernia (IH) after midline laparotomy, without its use being standardized. Knowing its radiological behaviour can resolve doubts about its use. Material and Methods This was a prospective observational cohort study. The included patients needed to have more than one risk factor for IH (age> 60 years old, Body Mass Index > 30kg/m2, diabetes, chronic bronchopathy, heart disease, smoking, kidney disease, neoplasia, liver disease, immunosuppression or an emergency operation). Follow-up included 6-week and 12-month postoperative magnetic resonance imaging (MRI). If MRI was not performed, we used the follow-up computed tomography (CT). Results Between July 2016 and March 2021, 54 patients were enrolled in the study. Surgery was emergent in 14.8% of cases, clean-contaminated in 87% and upper gastrointestinal surgery in 51.9%. A total of 43 MRI and 3 CT at 6-week and 30 MRI and 2 CT at 12-month were carried out. The median of the mesh area were 150.7 vs 150,1cm2 respectively. 91% of cases had the mesh lined to the fascia at 12 months. The bridging in the linea alba was zero in 61% at 6-weeks and 24% at 12-month follow-up, mean 9 vs 19mm (p = 0.001). Conclusions The use of imaging tests to know the postoperative behaviour of a Polyvinylidenfluorid (PVDF) “visible” mesh shows us that there is no mesh contraction at one year or detachment of the fascia, however we observe a significant tendency in the separation of the linea alba.

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Evaluation of Absorbable Mesh for Prophylactic Mesh Augmentation in High-Risk Patients

Surgical Technology Online ◽

10.52198/21.sti.38.hr1430 ◽

2021 ◽

Author(s):

Justin Faulkner ◽

Jordan Bilezikian ◽

Seth Beeson ◽

Rick Jernigan ◽

Sarah Fox ◽

...

Keyword(s):

High Risk ◽

Incisional Hernia ◽

Aortic Surgery ◽

Prophylactic Mesh ◽

Stoma Creation ◽

High Risk Patients ◽

Absorbable Mesh ◽

Hernia Prevention ◽

Mesh Augmentation ◽

Risk Patients

Purpose: Hernia prevention following abdominal surgery has become a subject of growing interest in general surgery. Prophylactic mesh augmentation (PMA) is an emerging technique to prevent incisional hernia in high-risk populations. The aim of this study was to determine the efficacy and safety of PMA using an absorbable mesh. Methods: A retrospective review was performed on patients who underwent PMA between July 2014 and March 2020. A prophylactic synthetic absorbable mesh (Phasix™; Becton Dickinson, Franklin Lakes, NJ) was placed at the surgeon’s discretion according to the indication for the primary operation. The primary outcome was the incisional hernia rate. Secondary outcomes included mesh-related or other complications. Results: Fifty patients underwent PMA following cystectomy with ileal conduit, open aortic surgery, or colostomy creation/takedown. Overall, 10 patients (20%) developed hernia at a median follow-up of 2.2 years. Six of these 10 hernias occurred at incisions where mesh was not placed. There were no documented mesh infections. One mesh (2%) in the AAA group was explanted due to an infected endograft, but there was no evidence of mesh complication. Two patients (4%) developed seroma. Two (4%) patients developed superficial surgical site infections (SSI). There were no documented deep-space SSI. Conclusion: PMA is an emerging technique with a low rate of incisional hernia in high-risk patients, such as those undergoing stoma creation or open aortic intervention. The use of an absorbable mesh seems promising, however more and longer-term research is needed.

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Does pre-emptive onlay mesh reinforcement of midline laparotomies reduce incidence of incisional hernia in high–risk patients?

International Surgery Journal ◽

10.18203/2349-2902.isj20192951 ◽

2019 ◽

Vol 6 (7) ◽

pp. 2300

Author(s):

Hosam F. Abdelhameed ◽

Samir A. Abdelmageed

Keyword(s):

High Risk ◽

Incisional Hernia ◽

Chronic Wound ◽

Midline Laparotomy ◽

High Risk Patients ◽

Wound Pain ◽

Risk Patients ◽

Onlay Mesh ◽

Group 2 ◽

Group 1

Background: One of the major morbidity after abdominal surgery is incisional hernia. In high risk patients its incidence reaches 11-20% despite various optimal closure techniques for midline laparotomy. Our aim is to evaluate the efficacy of onlay mesh placement in reducing the incidence of incisional hernia in those high risk patients.Methods: A total of 65 high risk patients suspected to develop post-operative incisional hernia underwent midline abdominal laparotomies. Patients were divided into two groups; group1 (30 patients) for whom the incision was closed by conventional method and group2 (35 patients) for whom the incision was closed with reinforcement by onlay polypropylene mesh. The primary end point was the occurrence of incisional hernia while the secondary end point was post-operative complications including subcutaneous seroma, chronic wound pain, and surgical site infection (SSI). Patients were followed up for two years.Results: The base line characteristics of the two groups were similar. The incidence of incisional hernia is significantly reduced 1/35 (2.8%) in group 2 while it was 6/30 (20%) in group 1. As regard seroma and chronic wound pain they increased in (group2) 6/35 (17.14%) and 5/35(14.28%) respectively compared to (group 1) which was 4/30 (13.33%) and 2/30 (6.66%). SSI occurred in 1/35 (2.85%) in group 2 and in 1/30 (3.33%) in group 1.Conclusions: Prophylactic onlay mesh reinforcement of the midline laparotomy for high risk patients can be used safely and markedly reduces the incidence of incisional hernia with little morbidity.

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A STING-related prognostic score predicts high-risk patients of colorectal cancer and provides insights into immunotherapy

Annals of Translational Medicine ◽

10.21037/atm-20-2430 ◽

2021 ◽

Vol 9 (1) ◽

pp. 14-14

Author(s):

Si-Yuan Chen ◽

Siyu Chen ◽

Wanjing Feng ◽

Ziteng Li ◽

Yixiao Luo ◽

...

Keyword(s):

Colorectal Cancer ◽

High Risk ◽

Prognostic Score ◽

High Risk Patients ◽

Risk Patients

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Preoperative Assessment of High-Risk Patients for Lung Cancer Resection

Medical Management of the Thoracic Surgery Patient ◽

10.1016/b978-1-4160-3993-8.00031-3 ◽

2010 ◽

pp. 288-292

Author(s):

Heather D. Jones ◽

Zab Mosenifar

Keyword(s):

Lung Cancer ◽

High Risk ◽

Preoperative Assessment ◽

Cancer Resection ◽

High Risk Patients ◽

Risk Patients

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Cost-effectiveness of a technology-supported multimodal prehabilitation program in moderate-to-high risk patients undergoing lung cancer resection: randomized controlled trial protocol

BMC Health Services Research ◽

10.1186/s12913-020-05078-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Anael Barberan-Garcia ◽

Ricard Navarro-Ripoll ◽

David Sánchez-Lorente ◽

Jorge Moisés-Lafuente ◽

Marc Boada ◽

...

Keyword(s):

Lung Cancer ◽

Randomized Controlled Trial ◽

Cost Effectiveness ◽

High Risk ◽

Controlled Trial ◽

Trial Protocol ◽

Cancer Resection ◽

High Risk Patients ◽

Randomized Controlled ◽

Risk Patients

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Stage IV Colorectal Cancer Patients with High Risk Mutation Profiles Survived 16 Months Longer with Individualized Therapies

Cancers ◽

10.3390/cancers12020393 ◽

2020 ◽

Vol 12 (2) ◽

pp. 393

Author(s):

Alexander Hendricks ◽

Anu Amallraja ◽

Tobias Meißner ◽

Peter Forster ◽

Philip Rosenstiel ◽

...

Keyword(s):

Colorectal Cancer ◽

Clinical Practice ◽

High Risk ◽

Metastatic Colorectal Cancer ◽

Cancer Patients ◽

Standard Of Care ◽

High Risk Patients ◽

Risk Patients ◽

Individualized Treatments ◽

Colorectal Cancer Patients

Personalized treatment vs. standard of care is much debated, especially in clinical practice. Here we investigated whether overall survival differences in metastatic colorectal cancer patients are explained by tumor mutation profiles or by treatment differences in real clinical practice. Our retrospective study of metastatic colorectal cancer patients of confirmed European ancestry comprised 54 Americans and 54 gender-matched Germans. The Americans received standard of care, and on treatment failure, 35 patients received individualized treatments. The German patients received standard of care only. Tumor mutations, tumor mutation burden and microsatellite status were identified by using the FoundationOne assay or the IDT Pan-Cancer assay. High-risk patients were identified according to the mutational classification by Schell and colleagues. Results: Kaplan–Meier estimates show the high-risk patients to survive 16 months longer under individualized treatments than those under only standard of care, in the median (p < 0.001). Tumor mutation profiles stratify patients by risk groups but not by country. Conclusions: High-risk patients appear to survive significantly longer (p < 0.001) if they receive individualized treatments after the exhaustion of standard of care treatments. Secondly, the tumor mutation landscape in Americans and Germans is congruent and thus warrants the transatlantic exchange of successful treatment protocols and the harmonization of guidelines.

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