pp 1–6 | Cite as

Hernia prevention: practice patterns and surgeons’ attitudes about abdominal wall closure and the use of prophylactic mesh

  • J. P. Fischer
  • H. W. Harris
  • M. López-Cano
  • W. W. HopeEmail author
Original Article



The penetration of hernia prevention techniques into surgical practice remains unknown.


A survey about knowledge/attitudes on hernia prevention was sent to the members of hernia societies.


The 497 respondents were mostly from the US (47%) or Europe (40%). Most reported practicing, but not measuring their suture-to-wound length closure of > 4:1 (63%) and practicing but not measuring the number of stitches (58%). Reasons for not using short stitch closure were: does not apply to patient population (19%), not familiar enough with methods to correctly execute (25%), takes too long (13%), not reimbursed (4%), concerned about closure-related complications (27%), and other (22%). Regarding prophylactic mesh, respondents stated they were not familiar with literature (11%), familiar with literature but would not use (24%), familiar with literature and interested in use (45%), familiar with literature and using (15%), and other (5%).


There appears to be some application of hernia prevention principles related to fascial closure; however, the use of prophylactic mesh still appears to be controversial.


Hernia Prevention Prophylactic Mesh Laparotomy 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

Dr. Hope declares the following potential conflicts of interest not directly related to the submitted work: has consulted for CR Bard/Davol, served as a speaker for Bard, WL Gore and Intuitive Surgical, and has received research funding from Bard and Gore. Dr. Fischer declares the following potential conflicts of interest not directly related to the submitted work: has consulted for Bard, WL Gore, and Allergan. Dr. López-Cano declares the following potential conflicts of interest not directly related to the submitted work: has received consultant fees from Bard, WL Gore, and B. Braun. Dr. Harris declares no conflict of interest.

Ethical approval

This study was deemed exempt by our Institutional Review Board.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained by all survey participants.


  1. 1.
    Cobb WS, Kercher KW, Heniford BT (2005) Laparoscopic repair of incisional hernias. Surg Clin North Am 85:91–103. ix.CrossRefGoogle Scholar
  2. 2.
    Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71CrossRefGoogle Scholar
  3. 3.
    Osther PJ, Gjode P, Mortensen BB, Mortensen PB, Bartholin J, Gottrup F (1995) Randomized comparison of polyglycolic acid and polyglyconate sutures for abdominal fascial closure after laparotomy in patients with suspected impaired wound healing. Br J Surg 82:1080–1082CrossRefGoogle Scholar
  4. 4.
    Israelsson LA, Jonsson T (1996) Incisional hernia after midline laparotomy: a prospective study. Eur J Surg 162:125–129Google Scholar
  5. 5.
    Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183. CrossRefGoogle Scholar
  6. 6.
    Lopez-Cano M, Brandsma HT, Bury K, Hansson B, Kyle-Leinhase I, Alamino JG, Muysoms F (2017) Prophylactic mesh to prevent parastomal hernia after end colostomy: a meta-analysis and trial sequential analysis. Hernia 21:177–189. CrossRefGoogle Scholar
  7. 7.
    Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Janes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, Lopez-Cano M, Maggiori L, Mandala V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Smietanski M, Szczepkowski M, Stabilini C, Muysoms FE (2017) European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia. Google Scholar
  8. 8.
    Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Janes A, Jeekel J, Lopez-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Smietanski M, Venclauskas L, Berrevoet F, European Hernia S (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24. CrossRefGoogle Scholar
  9. 9.
    Muysoms FE, Detry O, Vierendeels T, Huyghe M, Miserez M, Ruppert M, Tollens T, Defraigne JO, Berrevoet F (2016) Prevention of incisional hernias by prophylactic mesh-augmented reinforcement of midline laparotomies for abdominal aortic aneurysm treatment: a randomized controlled trial. Ann Surg 263:638–645. CrossRefGoogle Scholar
  10. 10.
    Jairam AP, Timmermans L, Eker HH, Pierik R, van Klaveren D, Steyerberg EW, Timman R, van der Ham AC, Dawson I, Charbon JA, Schuhmacher C, Mihaljevic A, Izbicki JR, Fikatas P, Knebel P, Fortelny RH, Kleinrensink GJ, Lange JF, Jeekel HJ, Group PT (2017) Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet 390:567–576. CrossRefGoogle Scholar
  11. 11.
    Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FP, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386:1254–1260. CrossRefGoogle Scholar
  12. 12.
    Israelsson LA (2015) Abdominal incision closure: small but important bites. Lancet 386:1216–1218. CrossRefGoogle Scholar
  13. 13.
    Janes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33:118–121. (discussion 122–113) CrossRefGoogle Scholar
  14. 14.
    Israelsson LA, Millbourn D (2013) Prevention of incisional hernias: how to close a midline incision. Surg Clin North Am 93:1027–1040. CrossRefGoogle Scholar
  15. 15.
    Williams ZF, Tenzel P, Hooks WB 3rd, Hope WW (2017) Suture to wound length ratio in abdominal wall closure: how well are we doing? Hernia 21:869–872. CrossRefGoogle Scholar
  16. 16.
    Muysoms FE, Jairam A, López-Cano M, Śmietański M, Woeste G, Kyle-Leinhase I, Antoniou SA, Köckerling F, Köckerling BSG, Antoniou F, Fortelny S, Granderath R, Heiss FA, Mayer M, Miserez F, Montgomery M, Morales-Conde A, Muysoms S, Petter-Puchner F, Pointner A, Smart R, Smietanski N, Stechemesser M B (2016) Prevention of incisional hernias with biological mesh: a systematic review of the literature. Front Surg. Google Scholar
  17. 17.
    Walhberg A, Poom L (2015) An empirical test of nonresponse bias in internet surveys. Basic Appl Soc Psychol 37:336–347. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • J. P. Fischer
    • 1
  • H. W. Harris
    • 2
  • M. López-Cano
    • 3
  • W. W. Hope
    • 4
    Email author
  1. 1.Department of SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of SurgeryUniversity of CaliforniaSan FranciscoUSA
  3. 3.Abdominal Wall Surgery Unit, Department of Surgery, Hospital Universitari Vall d’HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
  4. 4.Department of SurgeryNew Hanover Regional Medical CenterWilmingtonUSA

Personalised recommendations