EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen

López-Cano, Manuel; García-Alamino, Josep M; Antoniou, Stavros A.; Bennet, D.; Dietz, Ulrich; Ferreira, Fernando; Fortelny, René H.; Hernández-Granados, Pilar; Miserez, Marc; Montgomery, Agneta; Morales-Conde, Salvador; Muysoms, Filip; Pereira, José António; Schwab, Robert; Slater, Nicholas J.; Vanlander, Aude; Ramshorst, Gabriëlle H. van; Berrevoet, Frederik

doi:10.1007/s10029-018-1818-9

Cited by 69 publications

(69 citation statements)

References 128 publications

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“…Nevertheless, there is a higher risk of SSO associated with synthetic mesh use in contaminated and infected operations. 50 Therefore, most surgeons are reluctant to use it under these conditions, and many authors consider its use contraindicated. [28][29][30] We recognize the need for additional studies involving emergency operations, especially under conditions of contamination or infection, but we believe that the benefit of preventing incisional hernia and FD outweighs the risk of SSO because the management of these complications is limited to bedside procedures in most cases.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Lima

Rasslan

Novo

et al. 2020

Journal of the American College of Surgeons

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BACKGROUND: Fascial dehiscence (FD) occurs in up to 14.9% of high-risk patients undergoing emergency laparotomy. Although prophylactic mesh can prevent FD, its use in emergency operations remains controversial. STUDY DESIGN: A prospective randomized clinical trial was conducted at the Hospital das Clínicas from Faculdade de Medicina da Universidade de São Paulo in Brazil. It was performed among highrisk patients, defined according to Rotterdam risk model, undergoing midline emergency laparotomy. The patients were randomized into the suture group (SG), with slowly absorbable running sutures placed with a 36-mm-long needle at a suture-to-wound length ratio of 4:1, and the prophylactic mesh group (PMG), with fascial closure as in the SG but reinforced with onlay polypropylene mesh. The primary end point was incidence of FD at 30 days post operation. RESULTS: We analyzed 115 patients; 52 and 63 were allocated to the SG and PMG, respectively. In all, 77.4% of the cases were for colorectal resection. FD occurred in 7 (13.5%) patients in the SG and none in the PMG (p ¼ 0.003). There was no difference between the groups in number of patients with surgical site occurrence (SSO) or SSO requiring procedural intervention. However, some specific SSOs had higher incidences in the mesh group: surgical site infection (20.6% versus 7.7%; p ¼ 0.05), seroma (19.0% versus 5.8%; p ¼ 0.03), and nonhealing incisional wound (23.8% versus 5.8%; p ¼ 0.008). Of SSOs in the PMG and SG, 92.3% and 73.3%, respectively, resolved spontaneously or with bedside interventions. CONCLUSIONS: Prophylactic onlay mesh reinforcement in emergency laparotomy is safe and prevents FD. Surgical site infection, seroma, and nonhealing incisional wound were more common in the mesh group, but associated with low morbidity within 30 days post operation.

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Section: Discussionmentioning

confidence: 99%

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Lima

Rasslan

Novo

et al. 2020

Journal of the American College of Surgeons

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“…Our research group has acted as methodological and content coordinators of landmark surgical guidelines and have served as members of surgical guideline development groups. [9][10][11][12][13][14] Even though members of our group, in their role as guideline developers, have made every effort to comply with the highest methodological standards, as indicated by adherence to Grading of Recommendations Assessment, Development and Evaluation (GRADE) and AGREE II methodologies, 15 16 we noticed that compliance with all aspects of several parameters of the AGREE II instrument was not possible. For example, the item 'The potential resource implications of applying the recommendations have been considered' may be difficult to be universally addressed.…”

Section: Need For An Agree II Extensionmentioning

confidence: 99%

Protocol of an interdisciplinary consensus project aiming to develop an AGREE II extension for guidelines in surgery

et al. 2020

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IntroductionAppraisal of Guidelines for Research and Evaluation (AGREE II) is an instrument that informs development, reporting and assessment of clinical practice guidelines. Previous research has demonstrated the need for improvement in methodological and reporting quality of clinical practice guidelines specifically in surgery. We aimed to develop an AGREE II extension document for application in surgical guidelines.Methods and analysisWe have performed a structured literature review and assessment of guidelines in surgery using the AGREE II instrument. In exploratory analyses, we have identified factors associated with guideline quality. We have performed reliability and factor analyses to inform the development of an extension document. We will summarise this information and present it to a Delphi panel of stakeholders. We will perform iterative Delphi rounds and we will summarise the final results to develop the extension instrument in a dedicated consensus conference.Ethics and disseminationFunding bodies will not be involved in the development of the instrument. Research ethics committee and Health Research Authority approval was waived, since this is a professional staff study only and no duty of care lies with the National Health Service to any of the participants. Conflicts of interest, if any, will be addressed by reassigning functions or replacing participants with relevant conflicts. The results will be disseminated through publication in peer reviewed journals, the funders’ websites, social media and direct contact with guideline development organisations and peer-reviewed journals that publish guidelines.

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“…Studies have shown that VAC-IPOM in patients with OA treatments decrease re-operations, duration of hospital and ICU stay, and the incidence of incisional hernia, when compared with VAWCM, which represents the current standard of care [45,46].…”

Section: What About the Open Abdomen Closure?mentioning

confidence: 99%

The role of prophylactic mesh placement to prevent incisional hernia in laparotomy. Is it time to change practice?

Sugrue

Johnston

Zeeshan

et al. 2019

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EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen

Cited by 69 publications

References 128 publications

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

Protocol of an interdisciplinary consensus project aiming to develop an AGREE II extension for guidelines in surgery

The role of prophylactic mesh placement to prevent incisional hernia in laparotomy. Is it time to change practice?

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