Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review

Memba, Robert; Morató, O.; Estalella, Laia; Pavel, Mihai-Calin; Llàcer-Millán, Erik; Achalandabaso, Mar; Julià, Elisabet; Padilla, E.; Olona, Carles; O’Connor, Donal B; Jorba, Rosa

doi:10.1159/000521169

Cited by 4 publications

(5 citation statements)

References 48 publications

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“…However, no precise figures are available on this. However, studies with larger numbers of cases often report only the occurrence of incisional hernias and their risk factors, with no information on surgical management or follow-up [ 5 , 7 , 12 , 13 ]. It is conceivable that a relevant proportion of patients with incisional hernias after pancreatic surgery are subject to a watch and wait concept, as the hernia is not at the medical forefront.…”

Section: Discussionmentioning

confidence: 99%

“…To prevent incisional hernia, the combination of medial and transverse laparotomy should be avoided [ 8 ]. The use of mesh augmentation for closure of lateral incisions may reduce the incidence of incisional hernias [ 12 ]. The present analysis of data from the Herniamed Register is intended, on one hand, to shed light on the problems of treating transverse incisional hernias following complex upper abdominal procedures, such as pancreatic surgery, and on the other hand to compare the outcomes of open vs minimally invasive incisional hernia repair.…”

Section: Introductionmentioning

confidence: 99%

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Incisional hernia repair following pancreatic surgery—open vs laparoscopic approach

Krueger,

Patrzyk,

Hipp

et al. 2023

Hernia

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Introduction For pancreatic procedures, transverse and midline or combined approaches are used. Having an increased morbidity after pancreatic surgery, these patients have an increased risk of developing an incisional hernia. In the following, we will analyze how the results of incisional hernia surgery after pancreatic surgery are presented in the Herniamed Registry. Methods Hospitals and surgeons from Germany, Austria and Switzerland can voluntarily enter all routinely performed hernia operations prospectively into the Herniamed Registry. All patients sign a special informed consent declaration that they agree to the documentation of their treatment in the Herniamed Registry. Perioperative complications (intraoperative complications, postoperative complications, complication-related reoperations and general complications) are recorded up to 30 days after surgery. After 1, 5, and 10 years, patients and primary care physicians are contacted and asked about any pain at rest, pain on exertion, chronic pain requiring treatment or recurrence. This retrospective analysis of prospectively collected data compares the outcomes of minimally invasive vs open techniques in incisional hernia repair after pancreatic surgery. Results Relative to the total number of all incisional hernia patients in the Herniamed Registry, the proportion after pancreatic surgery with 1-year follow-up was 0.64% (n = 461) patients. 95% of previous pancreatic surgeries were open. Minimally invasive incisional hernia repair was performed in 17.1% and open repair in 82.9% of cases. 23.2% of the defects were larger than 10 cm and 32.8% were located laterally or were a combination of lateral and medial defects. Among the few differences between the collectives, a significantly higher rate of defect closure (58.1% vs 25.3%; p < 0.001) and drainage (72.8% vs 13.9%; p < 0.001) was found in the open repairs, and larger meshes were seen in the minimally invasive procedures (340.6 cm2 vs 259.6 cm2; p < 0.001). No difference deemed a risk factor for chronic postoperative pain was seen in the rate of preoperative pain between the open and minimally invasive procedures (Appendix Table 4) No significant differences were found in either the perioperative complications or at 1-year follow-up. Conclusions Incisional hernias after complex pancreatic surgery can be repaired safely and with a low recurrence rate in both open and minimally invasive techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incisional hernia repair following pancreatic surgery—open vs laparoscopic approach

Krueger,

Patrzyk,

Hipp

et al. 2023

Hernia

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“…They found a pooled IH incidence that ranged from 7.7% to 38.8%. They also described risk factors according to statistical significance and found that a high BMI, surgical site infection, ascites, Mercedes or reversed T incisions, and previous IH were related to a higher risk of developing an IH ( 29 ).…”

Section: Incisional Hernia After Hpb Surgerymentioning

confidence: 99%

“…And finally, the incision type, being the Mercedes and the reverse-T incisions the most related to IH appearance. Many other risk factors were described with low association with IH incidence, such as previous hernia surgery, running versus mass suture closure of the abdominal wall, preoperative chemotherapy, superficial wound dehiscence, subcutaneous and perirenal fat thickness, and malignancy, among others ( 29 ).…”

Section: Incisional Hernia After Hpb Surgerymentioning

confidence: 99%

“…It showed that the quality of evidence available is low and could not determine what was the best type of suture or closure technique in HPB surgery. They concluded that studies tend to lean towards using small bites with a running suture for fascial closure, as this has demonstrated benefits in reducing IH in midline laparotomies ( 29 ). This could be extrapolated to subcostal incisions but requires studies to generate evidence and recommendations.…”

Section: Closing the Incisionsmentioning

confidence: 99%

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Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen

Pedrique¹,

Lersundi²,

Oliveros³

et al. 2023

J. Abdom. Wall Surg.

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Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. These structures are fundamental for the correct functionality of the abdominal wall. When performing certain types of incisions, damage to the muscular or neurovascular component of the abdominal wall, as well as an inadequate closure technique may influence in the development of long-term complications as incisional hernias (IH) or bulging. Considering that both may impair quality of life and that are complex to repair, prevention becomes essential during these procedures. With the currently available evidence, there is no clear recommendation on which is the better incision or what is the best method of closure. Despite the lack of sufficient data, the following review aims to correlate the anatomical knowledge learned from posterior component separation with the incisions performed in hepato-pancreatic-biliary (HPB) surgery and their consequences on incisional hernia formation. Overall, there is data that suggests some key points to perform these incisions: avoid vertical components and very lateral extensions, subcostal should be incised at least 2 cm from costal margin, multilayered suturing using small bites technique and consider the use of a prophylactic mesh in high-risk patients. Nevertheless, the lack of evidence prevents from the possibility of making any strong recommendations.

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Incidence of and Risk Factors for Incisional Hernia After Hepatectomy for Colorectal Liver Metastases

Maki

Kim

Kawaguchi

et al. 2023

Journal of Gastrointestinal Surgery

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Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review

Cited by 4 publications

References 48 publications

Incisional hernia repair following pancreatic surgery—open vs laparoscopic approach

Incisional hernia repair following pancreatic surgery—open vs laparoscopic approach

Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen

Incidence of and Risk Factors for Incisional Hernia After Hepatectomy for Colorectal Liver Metastases

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