Effect of Incisional Negative Pressure Wound Therapy Following Incisional Hernia RepairA Randomised Controlled Trial

Abstract

Introduction: Incisional hernia is one of the common complications following abdominal surgery in patients undergoing laparotomy. Various surgical procedures are performed by creating a potential space and placing a foreign body (mesh), which may render the wound susceptible for many postoperative complications. It is clinically important to evaluate the efficacy of Incisional Negative Pressure Wound Therapy (INPWT) in reducing wound complications. Aim: To compare the efficacy of INPWT dressing with traditional gauze dressing in reducing postoperative complications following meshplasty in incisional hernia repair. Materials and Methods: This was a hospital-based randomised controlled trial, conducted in the Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, from October 2013 to July 2015. 64 consenting patients with incisional hernias undergoing meshplasty were included in this study. After being randomised into the two study groups, they had their postoperative wounds dressed with either INPWT (Group A) for five days, or traditional gauze (Group B) based dressings. Operative parameters like duration of surgery, type of dissection and type of skin sutures used were studied and analysed. Also, postoperative outcomes like Surgical Site Infection (SSI), seroma, duration of drain, hospital stay were analysed using Chi-square or Fisher’s-exact test. Results: Out of total 64 patients, there was a statistically significant reduction in the volume of drain (p=0.004) and duration of wound drainage (p=0.029) with the use of INPWT. There was also a reduction in the incidence of SSI (6.7% vs 17.6%) and seroma (6.7% vs 11.8%) and the duration of postoperative hospital stay (6.03±1.99 days vs 7.09±2.31 days) in the INPWT group, which were however not statistically significant. Age, comorbidities, Body Mass Index (BMI), duration of surgery, type of dissection and type of skin sutures were not found to have any effect on the parameters assessed. Conclusion: Incisional negative pressure wound therapy in postoperative wounds, following meshplasty for incisional hernia significantly reduces the volume and duration of wound drainage. It also reduces the incidence of SSI, seroma and the duration of hospital stay

Prophylactic negative pressure wound therapy in patients with closed surgical wound: An integrative review

“…The use of standard surgical dressing and emergency colorectal surgery were associated with a higher risk of developing SSI. In the results of Mondal et al, the group that received NPWT also had fewer patients developing SSI than the control group (19). However, in this study, where participants were intervened due to presenting incisional hernia, all documented SSIs were considered superficial.…”

“…Another of the conclusions found when analyzing the articles was the formation of seroma. Regarding this postoperative complication, Mondal et al and Chambers et al agree since both studies showed that the difference was not statistically significant between the two groups (19,25). In De Rooij et al study, during NPWT, the mastectomy wound surface was under external nominal negative pressure of 80 mmHg by the NPWT pump during seven days, and the results should point to a favorable effect on seroma formation.…”

“…Duration of surgery was also addressed in the article by Mondal et al and by Chambers et al (19,25). Both studies consider that the differences between the two groups are not statistically important or not significant.…”

“…Both studies consider that the differences between the two groups are not statistically important or not significant. Mondal et al also refer to the average drain rate and the average duration of wound drainage, being the only ones to address these results (19). Regarding the average drained flow, the authors indicate that the group submitted to NPWT revealed a statistically significant reduction in the drained volume, compared to the control group, with conventional gauze dressing.…”

Efficacy of prophylactic negative pressure wound therapy after open ventral hernia repair: a systematic review meta-analysis

“…There are some limitations of this meta-analysis. First, most studies involved in this meta-analysis were retrospective and only two RCTs were included, which may introduce a selection bias in the process [ 46 ]. Second, the definition of SSO was different among articles.…”