O30 THE INCIDENCE OF INCISIONAL HERNIA AT OSTOMY-REVERSAL SITE

Abstract Aim The purpose of this study was to evaluate the rate of incisional hernias at the ostomy site after reversal of the ostomy. Material and Methods We used retrospectively compiled database of patients who had undergone ostomy formation and ist reversal. All patients had their surgery performed between Jan. 2011 and December 2019. Patients history, added by clinical examination and CT-scan were performed in order to identify the incidence of incisional hernias. Different variables, like gender, surgical site infection (SSI) and BMI were evaluated as possible risk factors for hernia occurrence. Results Among totally included 224 patients in the study, 190 of all patients had reversal after loop-ileostomy (85%) and 34 patients had reversal after loop-colostomy (15%). Among all stoma reversal patients, 12,8 % developed incisional hernia at the stoma reversal site (n = 28). The incisional hernia occurrence at the ostomy reversal site was present in 20,0% in patients with clinically relevant SSI and only in 9,4% in patients where SSI was absent (p = 0,03). There was no statistical significance in hernia occurrence between both genders and among patients with low, normal and high BMI in our cohort of patients. Conclusions Incisional hernia after ostomy reversal is a common late surgical complication. All measurements that reduce SSI at the reversal site are important for lower hernia incidence. Prophylactic mesh implantation at stoma reversal sites may be considered in these patients.

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Prophylactic Onlay Mesh Implantation During Definitive Fascial Closure After Open Abdomen Therapy (PROMOAT): Absorbable or Non-absorbable? Methodical Description and Results of a Feasibility Study

Frontiers in Surgery ◽

10.3389/fsurg.2020.578565 ◽

2020 ◽

Vol 7 ◽

Author(s):

Sebastian Schaaf ◽

Robert Schwab ◽

Christoph Güsgen ◽

Arnulf Willms

Keyword(s):

Incisional Hernia ◽

Open Abdomen ◽

Fascial Closure ◽

Special Focus ◽

Term Outcome ◽

Mesh Implantation ◽

Incisional Hernias ◽

Onlay Mesh

Introduction: Incisional hernia development after open abdomen therapy (OAT) remains a common complication in the long run. To demonstrate the feasibility, we describe our method of prophylactic onlay mesh implantation with definitive fascial closure after open abdomen therapy (PROMOAT). To display the feasibility of this concept, we evaluated the short-term outcome after absorbable and non-absorbable synthetic mesh implantation as prophylactic onlay.Material and Methods: Ten patients were prospectively enrolled, and prophylactic onlay mesh (long-term absorbable or non-absorbable) was implanted at the definitive fascial closure operation. The cohort was followed up with a special focus on incisional hernia development and complications.Results: OAT duration was 21.0 ± 12.6 days (95% CI: 16.9–25.1). Definitive fascial closure was achieved in all cases. No incisional hernias were present during a follow-up interval of 12.4 ± 10.8 months (range 1–30 months). Two seromas and one infected hematoma occurred. The outcome did not differ between mesh types.Conclusion: The prophylactic onlay mesh implantation of alloplastic, long-term absorbable, or non-absorbable meshes in OAT showed promising results and only a few complications that were of minor concern. Incisional hernias did not occur during follow-up. To validate the feasibility and safety of prophylactic onlay mesh implantation long-term data and large-scaled prospective trials are needed to give recommendations on prophylactic onlay mesh implantation after OAT.

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Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement

Hernia ◽

10.1007/s10029-019-02042-3 ◽

2019 ◽

Vol 24 (1) ◽

pp. 93-98 ◽

Cited By ~ 1

Author(s):

A. G. Barranquero ◽

E. Tobaruela ◽

M. Bajawi ◽

P. Muñoz ◽

J. Die Trill ◽

...

Keyword(s):

Risk Factors ◽

Incisional Hernia ◽

Loop Ileostomy ◽

Ileostomy Closure ◽

Prophylactic Mesh ◽

Mesh Placement

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Long-term Follow-Up of Prophylactic Mesh Reinforcement After Emergency Laparotomy. Cohorts Study.

10.21203/rs.3.rs-104602/v1 ◽

2020 ◽

Author(s):

Alejandro Bravo-Salva ◽

Nuria Argudo-Aguirre ◽

Ana María González-Castillo ◽

Estela Membrilla-Fernandez ◽

Joan Sancho-Insenser ◽

...

Keyword(s):

Risk Factors ◽

Incisional Hernia ◽

Long Term Results ◽

Emergency Laparotomy ◽

Prophylactic Mesh ◽

Midline Laparotomy ◽

Incisional Hernias ◽

Mesh Reinforcement

Abstract BackgroundPrevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies. MethodsThis study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared. ResultsFrom an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62% vs. 43.2%; P=0.01) and operation due to a revision laparotomy (32.5% vs. 13%; P=0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P=0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR=2.47; 95% CI 1.318–4.624; P=0.05), contaminated surgery (HR=2.98; 95% CI 1.142–7.8; P=0.02), surgical site infection (SSI; HR=3.83; 95% CI 1.86–7.86; P=0.001), and no use of prophylactic mesh (HR=5.09; 95% CI 2.1–12.2; P=0.001). ConclusionIncidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and SSI benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate.

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Long-term follow-up of prophylactic mesh reinforcement after emergency laparotomy. A retrospective controlled study

BMC Surgery ◽

10.1186/s12893-021-01243-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

A. Bravo-Salva ◽

N. Argudo-Aguirre ◽

A. M. González-Castillo ◽

E. Membrilla-Fernandez ◽

J. J. Sancho-Insenser ◽

...

Keyword(s):

Risk Factors ◽

Incisional Hernia ◽

Surgical Site Infection ◽

Long Term Results ◽

Site Infection ◽

Prophylactic Mesh ◽

Incisional Hernias ◽

Mesh Reinforcement

Abstract Background Prevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies. Methods This study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared. Results From an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62 vs. 43.2%; P = 0.01) and operation due to a revision laparotomy (32.5 vs.13%; P = 0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P = 0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR = 2.47; 95% CI 1.318–4.624; P = 0.05), contaminated surgery (HR = 2.98; 95% CI 1.142–7.8; P = 0.02), surgical site infection (SSI; HR = 3.83; 95% CI 1.86–7.86; P = 0.001), and no use of prophylactic mesh (HR = 5.09; 95% CI 2.1–12.2; P = 0.001). Conclusion Incidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and surgical site infection (SSI) benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate. Trial registration: NCT04578561. www.clinicaltrials.gov

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Is there a role for prophylactic mesh in abdominal wall closure after emergency laparotomy? A systematic review and meta-analysis

Hernia ◽

10.1007/s10029-019-02060-1 ◽

2019 ◽

Vol 24 (3) ◽

pp. 441-447 ◽

Cited By ~ 1

Author(s):

F. A. Burns ◽

E. G. Heywood ◽

C. P. Challand ◽

Matthew J. Lee

Keyword(s):

Systematic Review ◽

Incisional Hernia ◽

Risk Ratio ◽

Meta Analysis ◽

Randomised Trial ◽

Emergency Laparotomy ◽

Confounding Factors ◽

Prophylactic Mesh ◽

Mesh Placement ◽

Incisional Hernias

Abstract Background Incisional hernias are a common complication of emergency laparotomy and are associated with significant morbidity. Recent studies have found a reduction in incisional hernias when mesh is placed prophylactically during abdominal closure in elective laparotomies. This systematic review will assess the safety and efficacy of prophylactic mesh placement in emergency laparotomy. Methods A systematic review was performed according to the PROSPERO registered protocol (CRD42018109283). Papers were dual screened for eligibility, and included when a comparison was made between closure with prophylactic mesh and closure with a standard technique, reported using a comparative design (i.e. case–control, cohort or randomised trial), where the primary outcome was incisional hernia. Bias was assessed using the Cochrane risk of bias in non-randomised studies tool. A meta-analysis of incisional hernia rate was performed to estimate risk ratio using a random effects model (Mantel–Haenszel approach). Results 332 studies were screened for eligibility, 29 full texts were reviewed and 2 non-randomised studies were included. Both studies were biased due to confounding factors, as closure technique was based on patient risk factors for incisional hernia. Both studies found significantly fewer incisional hernias in the mesh groups [3.2% vs 28.6% (p < 0.001) and 5.9% vs 33.3% (p = 0.0001)]. A meta-analysis of incisional hernia risk favoured prophylactic mesh closure [risk ratio 0.15 (95% CI 0.6–0.35, p < 0.001)]. Neither study found an association between mesh and infection or enterocutaneous fistula. Conclusion This review found that there are limited data to assess the effect or safety profile of prophylactic mesh in the emergency laparotomy setting. The current data cannot reliably assess the use of mesh due to confounding factors, and a randomised controlled trial is required to address this important clinical question.

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Prophylactic mesh placement to avoid incisional hernias after stoma reversal: a systematic review and meta-analysis

Hernia ◽

10.1007/s10029-019-01996-8 ◽

2019 ◽

Vol 23 (4) ◽

pp. 733-741 ◽

Cited By ~ 2

Author(s):

L. C. L. van den Hil ◽

S. van Steensel ◽

M. H. F. Schreinemacher ◽

N. D. Bouvy

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Prophylactic Mesh ◽

Mesh Placement ◽

Incisional Hernias ◽

Stoma Reversal

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Modifications in the production of cytokines and growth factors in drainage fluids following mesh implantation after incisional hernia repair

Yearbook of Surgery ◽

10.1016/s0090-3671(08)70210-6 ◽

2007 ◽

Vol 2007 ◽

pp. 275-277

Author(s):

K.I. Bland

Keyword(s):

Growth Factors ◽

Incisional Hernia ◽

Hernia Repair ◽

Incisional Hernia Repair ◽

Mesh Implantation

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Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

Advances in Urology ◽

10.1155/2015/457305 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Avinash Chennamsetty ◽

Jason Hafron ◽

Luke Edwards ◽

Scott Pew ◽

Behdod Poushanchi ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Incisional Hernia ◽

Operative Time ◽

Patient Counseling ◽

Incisional Hernias ◽

Prostate Weight ◽

History Of ◽

Robotic Assisted Radical Prostatectomy

Introduction.To explore the long term incidence and predictors of incisional hernia in patients that had RARP.Methods.All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair.Results.Of 577 patients, 48 (8.3%) had a hernia at an incisional site (35 men had umbilical), diagnosed at (median) 1.2 years after RARP (mean follow-up of 5.05 years). No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams;P=0.001) and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48) versus 4.6% (22/480);P=0.033). Overall, 4% (23/577) of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias.Conclusion.Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery.

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Appendiceal hernia: an extremely rare condition

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.7000 ◽

2021 ◽

Vol 103 (2) ◽

pp. e50-e52

Author(s):

GA Molina ◽

CL Rojas ◽

WG Aguayo ◽

MA Moyon ◽

P Gálvez ◽

...

Keyword(s):

Acute Appendicitis ◽

Incisional Hernia ◽

Rare Condition ◽

Full Recovery ◽

Incisional Hernias ◽

Inguinal Hernias ◽

Clinical Awareness

Appendix-associated hernias are extremely rare. They have been described sporadically in the literature, mostly as inguinal hernias. Appendix-associated incisional hernias are even more unusual. High clinical awareness is needed as complications can arise if misdiagnosis or delay occurs. We present an 80-year-old man with acute appendicitis in an incisional hernia. After successful surgery, the patient made a full recovery.

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