Incisional Hernia Prevention By Modification of The Abdominal Wall Closure Technique: Systematic Review And Meta-analysis

Background: Incisional hernia (IH) is the main complication after laparotomy. The objective of this meta-analysis was to evaluate the effectiveness of closure technique modification (CTM) for reducing the incidence of IH to provide objective support for its recommendation.Methods: A meta-analysis was performed according to the PRISMA guidelines. The primary objective was to determine the incidence of IH, and the secondary objective was to determine the incidence of acute evisceration and postoperative complications. Only published clinical trials were included. The risk of bias was analyzed, and the random effects model was used to determine statistical significance.Results: Nine studies comparing 2,612 patients were inclued. The incidence of IH was significantly lower in the CTM group than in the control group, with an OR of 0.39 (95% CI 0.26-0.57). The incidence of acute postoperative evisceration was also reduced, with an OR of 0.46 (95% CI 0.23-0.92). Associated complications, including hematoma, seroma, and postoperative pain, could not be analyzed; however, CTM did not increase the risk of surgical site infection.Conclusion: CTM for midline laparotomy significantly reduces the incidence of IH compared to conventional closure. Limitations of the analysis included differences in follow-up, patient selection, diagnostic methods, and the reporting of postoperative complications among the studies.Funding Information: No funding was received.Registration: This study was prospectively registered in the PROSPERO database under registration number CRD42021231107.

P051 NATIONAL TRENDS IN VOLUME, COSTS, AND PATIENT RISK PROFILE OF INPATIENTS UNDERGOING INCISIONAL HERNIA REPAIR IN RELATION TO ABDOMINAL SURGERY

Aim We describe trends in inpatient burden by volume, cost, and patient risk profiles of incisional hernia repair (IHR) as compared to other abdominal surgery (AS) procedures in the United States. Material and Methods Patients undergoing AS were identified using the National Inpatient Sample (2008-2018) by ICD-9/ICD-10 codes. National weighted procedure rates and hospital costs were ascertained and plotted using sampling weights and normalized per 1,000,000 people. Regression models allowed identification of statistical significance of trends and prediction of mean differences in rates, costs and patient characteristics. Results Over 38,000,000 AS discharges were identified, averaging 3.5 million annually, with over 1,200,000 discharges following IHR (3.1% of all AS). The difference between AS and IHR significantly decreased over time from 12,702 procedures per million (PPM) to 9,039 PPM. Open and laparoscopic AS down-trended (46.2% and 20.8%, respectively), whereas robotic AS up-trended (95.2% [all p < 0.01]). Open IHR down-trended (60.9%) and laparoscopic IHR up-trended (83.6%, [both p < 0.01]). Robotic IHR increased by 99.5% (p = 0.17). Average annual national charges for AS and IHR were $183.8 and $6.6 billion, respectively. Costs increased by 20.3% for AS and 25.6% for IHR. Patients undergoing IHR were 45-64 years old (46%), female (63.1%), White (68.1%), publicly insured (55.1%), with moderate loss of function (43.2%) and ≥2 comorbidities (43.3%). Conclusions IH continues to carry a significant societal and healthcare burden. With AS decreasing and IHR remaining stable from 2008 to 2018, the percentage of patients developing IH after AS has increased, as well as cost per IHR, critically underscoring the need to adopt and implement risk reduction and hernia prevention.

Evaluation of Absorbable Mesh for Prophylactic Mesh Augmentation in High-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.

Caesarean Scar Endometriosis May Require Abdominoplasty

Endometriosis is defined as an ectopic presence of endometrium-like tissue outside uterine cavity, which most commonly involves intraperitoneal organs. However, one of the less frequent forms of the disease is abdominal wall endometriosis usually developing in surgical scars following obstetric and gynaecological surgeries involving uterine cavity entering, that is, caesarean section, myomectomy or hysterectomy. In this case report we present a case of a patient with extensive caesarean scar endometriosis, who required complex surgical management. Successful surgical treatment involved not only radical tumour resection and application of mesh in postoperative hernia prevention but also adequate wound closure ensuring satisfactory cosmetic results, which was most challenging. The abdominal wall defect could not be sutured by traditional technique, thus polypropylene mesh was used and partial abdominoplasty was performed. The wound healed without complication and 24-month follow-up showed no evidence of local recurrence and satisfactory cosmetic result. In case of extensive endometrial abdominal wall tumours surgical treatment may involve application of advanced plastic surgery techniques, like abdominoplasty or skin/musculocutaneous flaps transposition.