Randomized Controlled Trial of the Use of a Large-pore Polypropylene Mesh to Prevent Incisional Hernia in Colorectal Surgery

Abstract

The incidence of IH is high in patients undergoing elective or emergency surgery for colorectal diseases. The addition of a prophylactic large-pore polypropylene mesh on the overlay position decreases the incidence of IH without adding morbidity.

Is there a role for prophylactic mesh in abdominal wall closure after emergency laparotomy? A systematic review and meta-analysis

“…Of these, two were eligible for inclusion. Reasons for exclusion were mesh as secondary closure (n = 3) [14][15][16], mesh as temporary closure (n = 1) [17], elective laparotomy (n = 4) [18][19][20][21], unable to retrieve article (n = 2) [22,23], not in English language (n = 7) [24][25][26][27][28][29][30], conference proceedings (n = 5) [31][32][33][34][35], duplicate (n = 1) [36], case report (n = 1) [37], non-GI indication for laparotomy (n = 1) [38] and non-mesh closure (n = 1) [39]. This is presented in the PRISMA flow diagram ( Fig.…”

Discovery of novel plasma proteins as biomarkers for the development of incisional hernias after midline incision in patients with colorectal cancer: The ColoCare study

“…Preventive measures are available, such as prophylactic mesh implantation, leading to a reduction of an incisional hernia within 2 years after surgery. 7 However, after analysis of the existing evidence, the European Hernia Society concludes “Although the data are favorable and consistent for prophylactic mesh augmentation, the Guidelines Development Group decided that larger trials are needed to make a strong recommendation to perform prophylactic mesh augmentation for all patients within certain risk groups.” 8 …”

The state of midline closure of the abdominal wall

“…A variety of new closure techniques (such as small bites, controlled traction) as well as sophisticated devices (elastic sutures, mesh sutures, mesh prophylaxis) are available and reflect the quest to reduce disturbingly high rates of incisional herniation. Results are mixed, however, with hernia rates ranging from 2 to 30 per cent in colorectal procedures, with equally high figures in open bariatric surgery. Despite this frequency, there is little evidence of significant improvement or alteration in surgical practice over the past three decades.…”

“…There is increasing evidence that non‐resorbable, or at least slowly resorbable, running sutures should be preferred over single sutures or resorbable materials. It is important to remember that the application of too much traction can cause ischaemia of entrapped muscle as well as trauma to the fascia, no matter what material has been chosen.…”

“…The latter alone seems a poor predictor of the development of an incisional hernia. Although prophylactic mesh placement has also been found beneficial in a recent study of open colorectal surgery, it is still not fully understood how much overlap is needed to prevent hernia development and whether resorbable biological mesh materials elicit sufficient ingrowth to provide a durable repair in the long term.…”