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

Sugrue, Michael; Johnston, Alison; Zeeshan, Saqib; Loughlin, Paula; Bucholc, Magda; Watson, Angus

doi:10.5114/ait.2019.87475

Cited by 5 publications

(4 citation statements)

References 39 publications

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“…Others also found a significant decrease in the incidence of IH [43][44][45][46][47], in some associated with a positive effect on QoL [43]. Sugrue et al [48] summarized the available evidence in more than 2700 patients showing that besides an optimal laparotomy closure technique, preventive mesh placement should be considered in higher risk patients and if not, surgeons need to question why. Our review also has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Mesh After Midline Laparotomy: Evidence is out There, but why do Surgeons Hesitate?

et al. 2021

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Background Incisional hernias have an impact on patients' quality of life and on health care finances. Because of high recurrence rates despite mesh repair, the prevention of incisional hernias with prophylactic mesh reinforcement is currently a topic of interest. But only 15% of surgeons are implementing it, mainly because of fear for mesh complications and disbelief in the benefits. The goal of this systematic review is to evaluate the effectiveness and safety of prophylactic mesh in adult patients after midline laparotomy. Methods An extensive literature search was performed in PubMed, Embase and CENTRAL until 9/5/2020 for RCTs and cohort studies regarding mesh reinforcement versus primary suture closure of a midline laparotomy. The quality of the articles was analyzed using the Scottish Intercollegiate Guidelines Network checklists. Revman 5 was used to perform a meta-analysis. Results Twenty-three articles were found with a total of 1633 patients in the mesh reinforcement group and 1533 in the primary suture group. An odds ratio for incisional hernia incidence of 0.37 (95% CI = [0.30, 0.46], p \ 0.01) with RCTs and of 0.15 (95% CI = [0.09,0.25], p \ 0.01) in cohort studies was calculated. Seroma rate shows a significant odds ratio of 2.18 (95% CI = [1.45, 3.29], p \ 0.01) in favor of primary suture. No increase was found regarding other complications. Conclusion The evidence for the use of prophylactic mesh reinforcement is overwhelming with a significant reduction in incisional hernia rate, but implementation in daily clinical practice remains limited. Instead of putting patients at risk for incisional hernia formation and subsequent complications, surgeons should question their arguments why not to use mesh reinforcement, specifically in high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Prophylactic Mesh After Midline Laparotomy: Evidence is out There, but why do Surgeons Hesitate?

et al. 2021

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“…The use of meshes for correction of incisional hernias has provided the use of several surgical approaches for their ideal positioning, in order to avoid increased intraperitoneal pressure and maintain respiratory mechanics at adequate levels. However, there are scientific barriers regarding the effectiveness of each one of them 6 . In this sense, experimental studies become important tools to aid in the development of more effective techniques 23 .…”

Section: Discussionmentioning

confidence: 99%

“…To allow the best results, several techniques have been described in humans for the placement of mesh, such as onlay, sublay, preperitoneal plane and intraperitoneal plane, besides the combination of different sites 6,7 . In addition, the placement of this prophylactic mesh appears to be effective regardless of location, being a safe technique that prevents an increased risk of seroma and chronic pain 4 .…”

Section: Introductionmentioning

confidence: 99%

Incisional hernia repair in rats: description of the sublay technique under videomagnification system

et al. 2022

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To describe the technique of sublay correction of incisional hernia in Wistar rats under videomagnification system. Methods: Five male rats of the species Rattus norvegicus, of the Wistar lineage, with body weight between 250-350 g and 60 days old were used. Incisional hernia was inducted in all animals. After that, the incisional hernia was immediately corrected by the sublay method. Results: There were no cases of recurrence of the incisional hernia after placement of the polypropylene mesh using the sublay technique. No postoperative complications were observed. Conclusion: The technique is suitable for execution in Wistar rats.

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“…Surgical mesh is a medical device that supports the repair of a hernia as it heals. The use of mesh decreases hernia recurrences and has thus become standard practice [9][10][11][12][13][14][15][16][17][18], and has even be considered prophylactically when closing an incision at the first laparotomy [19,20]. The vast majority of patients are greatly benefited by the use of mesh, and it would be hard, if not impossible, to practice hernia surgery currently without mesh except at specialized centers or in low resource settings.…”

Section: Introductionmentioning

confidence: 99%

Are Surgeons Going to Be Left Holding the Bag? Incisional Hernia Repair and Intra-Peritoneal Non-Absorbable Mesh Implant Complications

Kirkpatrick,

Coccolini,

Tolonen

et al. 2024

JCM

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Ventral incisional hernias are common indications for elective repair and frequently complicated by recurrence. Surgical meshes, which may be synthetic, bio-synthetic, or biological, decrease recurrence and, resultingly, their use has become standard. While most patients are greatly benefited, mesh represents a permanently implanted foreign body. Mesh may be implanted within the intra-peritoneal, preperitoneal, retrorectus, inlay, or onlay anatomic positions. Meshes may be associated with complications that may be early or late and range from minor to severe. Long-term complications with intra-peritoneal synthetic mesh (IPSM) in apposition to the viscera are particularly at risk for adhesions and potential enteric fistula formation. The overall rate of such complications is difficult to appreciate due to poor long-term follow-up data, although it behooves surgeons to understand these risks as they are the ones who implant these devices. All surgeons need to be aware that meshes are commercial devices that are delivered into their operating room without scientific evidence of efficacy or even safety due to the unique regulatory practices that distinguish medical devices from medications. Thus, surgeons must continue to advocate for more stringent oversight and improved scientific evaluation to serve our patients properly and protect the patient–surgeon relationship as the only rationale long-term strategy to avoid ongoing complications.

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

Cited by 5 publications

References 39 publications

Prophylactic Mesh After Midline Laparotomy: Evidence is out There, but why do Surgeons Hesitate?

Prophylactic Mesh After Midline Laparotomy: Evidence is out There, but why do Surgeons Hesitate?

Incisional hernia repair in rats: description of the sublay technique under videomagnification system

Are Surgeons Going to Be Left Holding the Bag? Incisional Hernia Repair and Intra-Peritoneal Non-Absorbable Mesh Implant Complications

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