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

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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Delayed Closure of Open Abdomen in Septic Patients Treated With Negative Pressure Vacuum Therapy and Dynamic Sutures: A 10-Years Follow-Up on Long-Term Complications

Frontiers in Surgery ◽

10.3389/fsurg.2020.611905 ◽

2021 ◽

Vol 7 ◽

Author(s):

Anna Theresa Hofmann ◽

Christopher May ◽

Karl Glaser ◽

René H. Fortelny

Keyword(s):

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Open Abdomen ◽

Fascial Closure ◽

Wound Therapy ◽

Surgical Interventions ◽

Incisional Hernias ◽

Operating Field

Introduction: Patients with open abdomen after surgical interventions associated with the complication of secondary peritonitis are successfully treated with negative pressure wound therapy. The use of dynamic fascial sutures reduces fascial lateralization and increases successful delayed fascial closure after open abdomen treatment.Methods: In 2017 we published the follow-up results of 38 survivors out of 87 open abdomen patients treated with negative pressure wound therapy and dynamic fascial sutures between 2007 and 2012. In our current study we present the 10-years follow-up results regarding long-term complications with the focus on incisional hernias and pain. Since 2017 seven more patients have died, hence 31 patients were included in the current study. The patients were asked to answer questions about specific long-term complications of OA treatment including pain, the presence of incisional hernias and subsequent surgical interventions. Demographic data and data regarding fascial closure after open abdomen treatment were collected. All results were analyzed quantitatively. The follow-up period was 8–13 years.Results: The median age was 69 (30–90) years, and 15 (48.4%) were females. Twenty-four patients (77.4%) responded to the questionnaire: Three patients (12.5%) suffered from pain in the original operating field, all three at rest but not during exercise. None of the patients required analgesic treatment. Eleven patients (45.8%) were found to have incisional hernias. Five out of 11 hernias (45.5%) were treated by surgery and did not declare any pain in the operating field. Among the patients with incisional hernias lower MPI (Mannheimer Peritonitis Index) at the time of primary surgery but more reoperations and treatment days were found. The technique of fascial closure was heterogenic and no differences in the occurrence of incisional hernia could be detected.Conclusion: The incidence of incisional hernias after open abdomen treatment is still high, but are associated with little pain in the original operating field. Further studies are required to investigate methods for fascial closure techniques after OA treatment.

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P111 HIGH RATE OF INCISIONAL HERNIA AFTER MASS CLOSURE OF BURST ABDOMEN

British Journal of Surgery ◽

10.1093/bjs/znab395.104 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Thomas Korgaard Jensen ◽

Ismail Gögenur ◽

Mai-Britt Tolstrup

Keyword(s):

Incisional Hernia ◽

High Rate ◽

Fascial Closure ◽

Closure Technique ◽

Burst Abdomen ◽

Incisional Hernias ◽

Mass Closure ◽

Long Term Effect

Abstract Aim This study investigated the long-term effect of a standardized strategy of fascial closure with a mass closure technique, using a slowly absorbable running stitch for burst abdomen and evaluated the incidence of incisional hernia in these patients. Material and Methods A single-center, retrospective study including all patients that underwent surgery for burst abdomen between June 2014 and April 2019 was followed up in October 2020 to report the rate of incisional hernias. Results 94 patients underwent surgery for burst abdomen. 80 patients was enrolled for follow up. Index surgery was acute in 78%. Incisional hernia rate was 33%. 30-day mortality rate was 24%. Conclusions Standardized surgery for burst abdomen with a standardized mass-closure technique still results in high rates of incisional hernias.

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Vacuum-Assisted Wound Closure and Permanent Onlay Mesh–Mediated Fascial Traction: A Novel Technique for the Prevention of Incisional Hernia after Open Abdomen Therapy Including Results From a Retrospective Case Series

Scandinavian Journal of Surgery ◽

10.1177/1457496918818979 ◽

2018 ◽

Vol 108 (3) ◽

pp. 216-226 ◽

Cited By ~ 7

Author(s):

P. Petersson ◽

A. Montgomery ◽

U. Petersson

Keyword(s):

Incisional Hernia ◽

Wound Closure ◽

Open Abdomen ◽

Case Series ◽

Fascial Closure ◽

Short Term ◽

Retrospective Case ◽

Patient Reported ◽

Onlay Mesh

Background and Aims: Incisional hernia development is a frequent long-term sequel after open abdomen treatment. This report describes a novel technique, the vacuum-assisted wound closure and permanent onlay mesh–mediated fascial traction for temporary and final closure of the open abdomen, with the intention to decrease incisional hernia rates. Primary aim was to evaluate incisional hernia development and secondary aims to describe short-term complications and patient-reported outcome. Materials and Methods: The basics of the technique is an onlay mesh, applied early during open abdomen treatment by suturing to the fascia in two rows with a 3- to 4-cm overlap from the midline incision, used for traction and kept for reinforced permanent closure. A retrospective case series, including chart review, evaluation of computed tomography/ultrasound images, and an out-patient clinical examination were performed. The patients were asked to answer a modified version of the ventral hernia pain questionnaire. Results: A total of 11 patients were treated with vacuum-assisted wound closure and permanent onlay mesh–mediated fascial traction with median follow-up of 467 days. Fascial closure rate was 100% and 30 day mortality 0%. Two of nine patients, eligible for incisional hernia follow-up, developed a hernia. Neither of the hernias were symptomatic nor clinically detectable. Six of 10 patients eligible for short-term follow-up had a prolonged wound-healing time exceeding 3 weeks. One of seven patients eligible for patient-reported outcome have had pain during the last week. Conclusion: The vacuum-assisted wound closure and permanent onlay mesh–mediated fascial traction is a promising new technique for open abdomen treatment and reinforced fascial closure. The results of the first 11 patients treated with this technique show a low incisional hernia rate with manageable short-term wound complications and few patient-reported disadvantages.

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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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Long-term Outcome of Incisional Hernia Repairs Using the Erlangen Inlay Onlay Mesh (EIOM) Technique

Journal of Surgical Research ◽

10.1016/j.jss.2019.04.045 ◽

2019 ◽

Vol 243 ◽

pp. 14-22

Author(s):

Nizameddin Ayik ◽

Peter Klein ◽

Robert Grützmann ◽

Resit Demir

Keyword(s):

Incisional Hernia ◽

Term Outcome ◽

Long Term Outcome ◽

Onlay Mesh

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Long Term Outcome After Open Abdomen Treatment: Function and Quality of Life

Frontiers in Surgery ◽

10.3389/fsurg.2021.590245 ◽

2021 ◽

Vol 8 ◽

Author(s):

Alexis Theodorou ◽

Agnes Jedig ◽

Steffen Manekeller ◽

Arnulf Willms ◽

Dimitrios Pantelis ◽

...

Keyword(s):

Quality Of Life ◽

Open Abdomen ◽

Fascial Closure ◽

Secondary Reconstruction ◽

Secondary Stage ◽

Primary Fascial Closure ◽

Hernia Incidence

Background: Open abdomen treatment (OAT) is widely accepted to manage severe abdominal conditions such as peritonitis and abdominal compartment syndrome but can be associated with high morbidity and mortality. The main risks in OAT are (1) entero-atmospheric fistula (EAF), (2) failure of primary fascial closure, and (3) incisional hernias. In this study, we assessed the long-term functional outcome after OAT to understand which factors impacted most on quality of life (QoL)/daily living activities and the natural course after OAT.Materials and Methods: After a retrospective analysis of 165 consecutive OAT patients over a period of 10 years (2002–2012) with over 65 clinical parameters that had been performed at our center (1), we initiated a prospective structured follow-up approach. All survivors were invited for a clinical follow-up. Forty complete datasets including clinical and social follow-up with SF-36 scores were available for full analysis.Results: The patients were dominantly male (75%) with a median age of 52 years. Primary fascial closure (PC) was achieved in 9/40 (23%), while in 77% a planned ventral hernia (PVH) approach was followed. A total of 3/4 of the PVH patients underwent a secondary-stage abdominal wall reconstruction (SSR), but 2/3 of these reconstructed patients developed recurrent hernias. Fifty-five percent of the patients with PC developed an incisional hernia, while 20% of all patients developed significant scarring (Vancouver Scar Score >8). Scar pain was described by 15% of the patients as “moderate” [Visual Analog Scale (VAS) 4–6] and by 10% as “severe” (VAS > 7). While hernia presence, PC or PVH, and scarring showed no impact on QoL, male sex and especially EAF formation significantly reduced QoL.Discussion: Despite many advantages, OAT was associated with relevant mortality and morbidity, especially in the early era before the implementation of a structured concept at our center. Follow-up revealed that hernia incidence after OAT and secondary reconstruction were high and that 25% of patients qualifying for a secondary reconstruction either did not want surgery or were unfit. Sex and EAF formation impacted significantly on QoL, which was lower than in the general population. With regard to hernia incidence, new strategies such as prophylactic mesh implantation upon fascial closure should be discussed analogous to other major abdominal procedures.

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Abdominal incision defect following AAA-surgery (AIDA): 2-year results of prophylactic onlay-mesh augmentation in a multicentre, double-blind, randomised controlled trial

Updates in Surgery ◽

10.1007/s13304-021-01125-0 ◽

2021 ◽

Author(s):

S. Honig ◽

H. Diener ◽

T. Kölbel ◽

W. Reinpold ◽

A. Zapf ◽

...

Keyword(s):

Incisional Hernia ◽

Controlled Trial ◽

Fascial Closure ◽

Absorbable Suture ◽

Double Blind ◽

Midline Laparotomy ◽

Mesh Augmentation ◽

Onlay Mesh ◽

Randomised Controlled

AbstractThe reported incidence of incisional hernia following repair of abdominal aortic aneurysm (AAA) via midline laparotomy is up to 69%. This prospective, multicenter, double-blind, randomised controlled trial was conducted at eleven hospitals in Germany. Patients aged 18 years or older undergoing elective AAA-repair via midline incision were randomly assigned using a computer-generated randomisation sequence to one of three groups for fascial closure: with long-term absorbable suture (MonoPlus®, group I), long-term absorbable suture and onlay mesh reinforcement (group II) or extra long-term absorbable suture (MonoMax®, group III). The primary endpoint was the incidence of incisional hernia within 24 months of follow-up, analysed by intention to treat. Physicians conducting the postoperative visits and the patients were blinded. Between February 2011 and July 2013, 104 patients (69.8 ± 7.7 years) were randomised, 99 of them received a study intervention. The rate of incisional hernia within 24 months was not significantly reduced with onlay mesh augmentation compared to primary suture (p = 0.290). Furthermore, the rate of incisional hernia did not differ significantly between fascial closure with slow and extra long-term absorbable suture (p = 0.111). Serious adverse events related to study intervention occurred in five patients (5.1%) from treatment groups II and III. Wound healing disorders were more frequently seen after onlay mesh implantation on the day of discharge (p = 0.010) and three (p = 0.009) and six (p = 0.023) months postoperatively. The existing evidence on prophylactic mesh augmentation in patients undergoing AAA-repair via midline laparotomy probably needs critical review. As the implementation of new RCTs is considered difficult due to the increasing number of endovascular AAA treated, registry studies could help to collect and evaluate data in cases of open AAA-repair. Comparisons between prophylactic mesh implantation and the small bite technique are also required. Trial registration: ClinicalTrials.gov Identifier: NCT01353443. Funding Sources: Aesculap AG, Tuttlingen, Germany.

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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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Incisional hernia after liver transplantation: mesh-based repair and what else?

Surgery Today ◽

10.1007/s00595-020-02162-9 ◽

2020 ◽

Author(s):

Aristotelis Perrakis ◽

Dagmar Knüttel ◽

Mirhasan Rahimli ◽

Mihailo Andric ◽

Roland S. Croner ◽

...

Keyword(s):

Liver Transplantation ◽

Incisional Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Term Outcome ◽

Long Term Outcome ◽

Onlay Technique ◽

Median Period ◽

Onlay Mesh

Abstract Purpose Incisional hernia (IH) is not uncommon after liver transplantation (LT). We investigated the long-term outcome of mesh-based hernia repair using an inlay-onlay technique. Methods Our analysis was based on a prospective collected database of all LT recipients from our hospital over a period of 15 years. We analyzed clinical data including the period between LT and hernia development, the size and localization of the hernia, the length of in-hospital stay, immunosuppression, and postoperative morbidity, as well as follow-up data. The median follow-up period was 120 (range 12–200) months. Results Among a total of 220 patients who underwent a collective 239 LTs, 29 (13%) were found to have an IH after a median period of 27.5 months (range 3–96 months). There were 12 (41%) men and 17 (59%) women, with a median age of 51 years. The median size of the IH was 13 cm (range 2–30 cm) and the median in-hospital stay was 6 days. Mild postoperative complications developed in seven patients, including two onlay mesh infections. One patient (3.4%) suffered recurrence. Conclusion Mesh-based hernia repair using the inlay/onlay technique represents an effective and safe method for patients with an IH after LT, without additional risk from continuous immunosuppression.

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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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