Incisional Reinforcement in High-Risk Patients

Abstract

Hernia formation after surgical procedures continues to be an important cause of surgical morbidity. Incisional reinforcement at the time of the initial operation has been used in some patient populations to reduce the risk of subsequent hernia formation. In this article, reinforcement techniques in different surgical wounds are examined to identify situations in which hernia formation may be prevented. Mesh use for midline closure, pelvic floor reconstruction, and stoma site reinforcement is discussed. Additionally, the use of retention sutures, closure of the open abdomen, and reinforcement after component separation are examined using current literature. Although existing studies do not support the routine use of mesh reinforcement for all surgical incisions, certain patient populations appear to benefit from reinforcement with lower rates of subsequent hernia formation. The identification and characterization of these groups will guide the future use of mesh reinforcement in surgical incisions.

Risk factors associated to incisional hernia in stoma site after stoma closure: A systematic review and meta-analysis

“…Hernias are a complex and well-known medical problem, in which the patient can experience pain, impossibility to work, disfiguring and body image issues, decrease in the quality of life and requiring an emergency abdominal surgery due to intestinal obstruction or strangulation (1). One of the alternatives to help prevent incisional hernia and their consequences are the use of a prophylactic mesh, which have been proven to reduce incisional hernia rates after stoma closure (6,46,47).…”

Incisional Hernia Post Laparotomy-Incidence and Risk Factors

“…Another set of factors relates purely with the technique used to close the wound, choice of suture material and expertise of the surgeon [2,4,7,11].…”

“…The reported incidence is highly variable depending on underlying disease, type of incision used, length of follow up and method for hernia detection. Numerous risk factors associated with an increased incisional hernia incidence have been reported, including gender (both male and female), age, surgical site infection, obesity and aortic aneurysm [1,4,11,6]. Another set of factors relates purely with the technique used to close the wound, choice of suture material and expertise of the surgeon [2,4,7,11].…”

“…Incisional hernia can be a challenging clinical problem especially in morbidly obese patients, patients who have diabetes and who are steroid users. Other researchers have studied the clinical impact of morbid obesity and steroid use on the incidence of incisional hernia and found to have a protective effect of polypropylene mesh on the incidence of incisional hernia [4,9,11].…”