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Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review

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Abstract

Purpose

Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable morbidity and expenses. In this critical review, the issue is explored by an interdisciplinary group.

Methods

A group of European surgeons encompassing representatives from abdominal wall, vascular, urological, gynecological, colorectal and hepato-pancreatico-biliary surgery have reviewed the occurrence of His in these disciplines.

Results

Incisional hernias are a major public health issue with appreciable morbidity and cost implications. General surgeons are commonly called upon to repair IHs following an initial operation by others. Measures that may collectively reduce the frequency of IH across specialities include better planning and preparation (e.g. a fit patient, no time pressure, an experienced operator). A minimally invasive technique should be employed where appropriate. Our main recommendations in midline incisions include using the ‘small bites’ suture technique with a ≥ 4:1 suture-to-wound length, and adding prophylactic mesh augmentation in patients more likely to suffer herniation. For off-midline incisions, more research of this problem is essential.

Conclusion

Meticulous closure of the incision is significant for every patient. Raising awareness of the His is necessary in all surgical disciplines that work withing the abdomen or retroperitoneum. Across all specialties, surgeons should aim for a < 10% IH rate.

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Acknowledgements

Writing support to the authors was provided by Steven Walker and Robert Davies at Stgilesmedical London and Berlin (http://www.stgmed.com). Editing was by Sarah Stinnissen.

POP (Progress On Prevention) Surgical Group: Frederik Berrevoet, Diego Cuccurullo, Karel Decaestecker, Miguel Angel Garcia-Urena, Manuel López-Cano, Jose Molina, Javier de Santiago, Arne Seternes, Cesare Stabilini.

POP (Progress On Prevention) Surgical Group: Frederik Berrevoet, Diego Cuccurullo, Karel Decaestecker, Miguel Angel Garcia-Urena, Manuel López-Cano, Jose Molina Villar, Javier de Santiago Garcia, Arne Seternes, Cesare Stabilini. Frederik Berrevoet, Associate Professor, Director, Department of General, HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium. Diego Cuccurullo, Director, Department of General Surgery, Ospedali dei Colli, Ospedale Monaldi Napoli, Naples, Italy. Karel Decaestecker, Associate Professor, Urologie-Uro-oncologie-Robotchirurgie and Niertransplantatie. Ghent University Hospital, Ghent, Belgium. Miguel Angel Garcia-Urena, Medical Director, General and Gastrointestinal Surgery Department, Universidad Francisco de Vitoria. Hospital Universitario del Henares, Madrid, Spain. Manuel López-Cano, Director, Abdominal Wall Surgery Unit, University Hospital Vall d’Hebron, Barcelona, Spain. Jose Molina, Department of General Surgery/Surgery of the Digestive System, Hospital Universitario Ramón y Cajal, Madrid, Spain. Javier de Santiago, Director, Gynaecology Oncology Unit, MD Anderson Cancer Center, Madrid, Spain. Arne Seternes, Consultant Surgeon, Department of Vascular Surgery, St Olav’s University Hospital, Trondheim, Norway. Cesare Stabilini, Associate Professor, Department of General Surgery, IRCCS Azienda Ospedaliera Universitaria San Martino IST, Genoa, Italy.

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Meetings of the contributors and the correct writing of this manuscript were supported by an educational grant from Medtronic Inc. The company had no influence on the contents of this manuscript.

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  1. Hospital Universitario del Henares, Faculty of Health Sciences. Universidad Francisco de Vitoria, 28223, Pozuelo de Alarcón, Madrid, Spain

    M. A. Garcia-Urena, F. Berrevoet, D. Cuccurullo, K. Decaestecker, M. Angel Garcia-Urena, M. López-Cano, J. Manuel Molina Villar, J. de Santiago Garcia, A. Seternes & C. Stabilini

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POP (Progress On Prevention) Surgical Group

  • F. Berrevoet
  • , D. Cuccurullo
  • , K. Decaestecker
  • , M. Angel Garcia-Urena
  • , M. López-Cano
  • , J. Manuel Molina Villar
  • , J. de Santiago Garcia
  • , A. Seternes
  •  & C. Stabilini

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Correspondence to M. A. Garcia-Urena.

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Garcia-Urena, M.A., POP (Progress On Prevention) Surgical Group. Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review. Hernia 25, 13–22 (2021). https://doi.org/10.1007/s10029-020-02348-7

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