Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool

Pereira Rodríguez, José Antonio; Amador Gil, Sara; Bravo-Salva, Alejandro; Montcusí Ventura, Blanca; Sancho Insenser, Juan; Pera Roman, Miguel; López Cano, Manuel

doi:http://dx.doi.org/10.1007/s10029-021-02527-0

Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool

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Pereira-Rodríguez JA, Amador-Gil S, Bravo-Salva A, Montcusí-Ventura B, Sancho-Insenser J, Pera-Román M, López-Cano M. Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool. Hernia. 2022 Apr;26(2):457-66. DOI: 10.1007/s10029-021-02527-0

Abstract

Purpose: The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes. Methods: Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB. Results: A lower number of FD appeared in the M group (OR 0.0692; 95% CI 0.008-0.56; P = 0.01) in 197 operations. After a mean follow-up of 29.23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0.769; 95% CI 0.65-0.91; P < 0.0001). (33) The observed differences persisted after a propensity matching score: FD (OR 0.355; 95% CI 0.255-0.494; P < 0.0001) and IH (OR 0.394; 95% CI 0.24-0.61; P < 0.0001). On comparing suturing techniques by subgroups, both mesh subgroups had better outcomes. PM was the main factor related to the reduction of IH (HR 11.794; 95% CI 4.29-32.39; P < 0.0001). Conclusion: Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used.