Implementing a protocol to prevent incisional hernia in high-risk patients : a mesh is a powerful tool
Pereira-Rodríguez, José Antonio (Parc de Salut MAR de Barcelona)
Amador Gil, Sara (Hospital del Mar (Barcelona, Catalunya))
Bravo-Salva, Alejandro (Parc de Salut MAR de Barcelona)
Montcusí-Ventura, B. (Parc de Salut MAR de Barcelona)
Sancho Insenser, Joan Josep (Hospital del Mar (Barcelona, Catalunya))
Pera-Román, M. (Hospital del Mar (Barcelona, Catalunya))
López Cano, Marc (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes. Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB. A lower number of FD appeared in the M group (OR 0. 0692; 95% CI 0. 008-0. 56; P = 0. 01) in 197 operations. After a mean follow-up of 29. 23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0. 769; 95% CI 0. 65-0. 91; P < 0. 0001). (33) The observed differences persisted after a propensity matching score: FD (OR 0. 355; 95% CI 0. 255-0. 494; P < 0. 0001) and IH (OR 0. 394; 95% CI 0. 24-0. 61; P < 0. 0001). On comparing suturing techniques by subgroups, both mesh subgroups had better outcomes. PM was the main factor related to the reduction of IH (HR 11. 794; 95% CI 4. 29-32. 39; P < 0. 0001). Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Abdominal wall closure ; Laparotomy closure ; Incisional hernia ; Small bites ; Short stitch ; Prophylactic mesh
Publicat a:	Hernia, Vol. 26 (november 2021) , p. 457-466, ISSN 1248-9204

DOI: 10.1007/s10029-021-02527-0
PMID: 34724119

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