Abstract
Introduction
Incisional hernia is a long-term complication of laparotomy. Its exact frequency varies according to different authors, but is always around 10–15%. There are patients who present with systemic associated diseases [chronic obstructive pulmonary disease (COPD), obesity, severe cardiopathies, immunodeficiencies, etc.] that favour or increase the risk of appearance of an incisional hernia. The aim of the present study was to assess whether the prophylactic placement of a polypropylene mesh in patients at risk can reduce or avoid the appearance of an incisional hernia.
Materials and methods
Seventy-two selected patients with clear risk factors and colon pathology underwent surgical intervention through median infraumbilical laparotomy. During laparotomy the preperitoneal space was dissected at a point where a low-molecular weight polypropylene mesh was to be placed when closing the peritoneum. Meshes were about 7–8 cm wide and had a variable length that depended on the length of the surgical incision. Of the 72 patients, 41 were obese (BMI > 30 kg/m2), 45 presented with COPD, and 42 with colorectal neoplasia; 29 patients had two risk factors, and 15 had three risk factors. The mesh was held in place with polypropylene stitches in 28% of cases, and with fibrin glue in 72% of cases.
Results
All patients were assessed by a protocol that included interview, examination of the surgical wound, and abdominal CT scan. Follow-up was between 3 and 5 years. There were no noteworthy complications or operative mortality. No mesh had to be removed in any patient. Two patients developed liver metastasis, and in a second surgery the good condition of the abdominal wall and the absence of hernia were confirmed. Twenty patients required postoperative chemotherapy. Two patients died at 37 and 43 months after surgery because of progression of the neoplastic disease. Fourteen patients were monitored for more than 5 years after surgery, and 46 patients were monitored for 48 months. None of the 72 patients developed an incisional hernia.
Conclusion
Prophylactic use of a low-molecular-weight polypropylene mesh in abdominal surgery may be useful for the prevention of incisional hernia.
Similar content being viewed by others
Notes
V. Schumpelick, personal communication.
References
Ellis H, Gajraj H, George CD (1983) Incisional hernia. When do they occur? Br J Surg 70:290–293
Bucknall TE, Cox P, Ellis H (1982) Burst abdomen and incisional hernia: a prospective study of 1129 mayor laparotomies. BMJ 284:931–933
Stoppa R (1989) The treatment of groin and incisional hernia. World J Surg 13:545–554
Mudge M, Hughes L (1985) Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg 72:70–71
Conze J, Klinge U, Schumpelick V (2005) Incisional hernia. Chirurg 76(9):897–909
Colonbo M, Maggioni A, Parma G, Scalambrino S, Milari R (1997) A randomized comparison of continuous versus interrupted mass closure of midline incisions in patients with gynecologic cancer. Obstet Gynecol 89:684–689
Sugerman HJ, Kellun JM Jr, Reines HD, De Maria EJ, Newsome HH, Lowry JW (1996) Greater risk of incisional hernia with morbidly obese than steroid–dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171:80–84
Anthony T, Bergen P, L Kim et al (2000) Factors affecting recurrence following incisional herniorrhaphy. World J Surg 24:95–101
Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8:42–46
Schumpelick V, Klinge U, Welty G, Klosterhalfen B (1998) Meshes within the abdominal wall. Chirurg 70(8):876–887
Schumpelick V (2001) Does every hernia demand a mesh repair? A critical review. Hernia 5:5–8
Hesselink VJ, Luifendijk RW, De Wilt JHW, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstetric 176:228–234
Burger JW, Luisendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeckel J et al (2004) Long-term follow-up of a randomized, controlled trial of suture versus mesh repair of incisional Hernia. Ann Surg 240:578–585
Crovella F, Bartone G, Fei L (2008) Incisional hernia. Notes concerning current pathophysiological aspects of incisional hernia. Updates in surgery. Part. I. Springer, Berlin, pp 73–78
Misiakos EP, Machairas A, Patapis P, Liakakos T (2008) Laparoscopic ventral hernia repair: pros and cons compared with open hernia repair. JSLS 12:117–125
Poldermans D, Bax JJ, Boersma E et al (2009) Guías clinicas para la valoración del riesgo cardiaco preoperatorio en cirugía no cardiaca (Clinical guidelines for the preoperative assessment of cardiac risk in noncardiac surgery). Rev Esp Cardiol 62:1467e1–1467e56
Yahchouchy-Chouillar E, Aura T, Picone O, Etienne J, Fingerhut A (2003) Incisional hernias: related risk factors. Dis Surg 20:3–9
Cheng H, Rupprecht F, Jackson D, Berg T, Seelig MH (2007) Decision analysis model of incisional hernia after open abdominal surgery. Hernia 11:129–137
Rudmik LR, Schieman C, Dixon E, Debru E (2006) Laparoscopic ventral hernia repair: a review of the literature. Hernia 10:110–119
Conze J, Kignsnorth AN, Flament JB, Simmermacher R, Arlt G, Lauger C, Schippers E, Hartley M, Schumpelick V (2005) Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair. Br J Surg 92:1488–1493
Israelson LA, Smedberg S, Montgomery A, Nordin P, Spangen L (2006) Incisional hernia repair in Sweden 2002. Hernia 10(3):258–261
Schumpelick V (2002) Retromuscular mesh repair for ventral incisional hernia in Germany. Chirurg 73:888–894
van der Linde FT, van Vroonhoven TJ (1998) Long-term result alter surgical correction of incisional hernia. Neth J Surg 40:127–129
Paul A, Korenkov M, Peters S et al (1998) Unacceptable results of the Mayo procedure for repair of abdominal incisional hernias. Eur J Surg 164:361–367
Schecter WP, Ivatury RR, Rotondo MF, Hirshberg A (2006) Open abdomen after trauma and abdominal sepsis: a strategy for management. J Am Coll Surg 203:390–396
Bauer JJ, Salky BA, Gelernt IM, Kree I (1987) Repair of large abdominal wall defects with expanded polytetraflouethylene. Ann Surg 206:765–769
Bendavid R (2007) Composite mesh (polypropylene-e-PTFE) in the intraperitoneal mesh. Hernia 11:315–320
Peirolini D, Mazzucchi E et al (2001) Prosthetic repair of incisional hernia in kidney transplant patients. A technique with onlay polypropylene mesh. Hernia 5:31–35
Carlson MA, Frantzides CT, Shostrom VK, Laguna LE (2008) Minimally invasive ventral herniorrhaphy. An analysis of 6266 published cases. Hernia 12:9–22
Cobb WS, Kecher KW, Heniford BT (2005) Laparoscopic repair of incisional hernia. Surg Clin North AM 85:91–103
Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population based analysis. Ann Surg 237:129–135
Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias. Nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–400
Read R, Yoder G (1989) Recent trends in the management of incisional herniation. Arch Surg 124:485–488
Sorensen LT, Hemmingsen UB, Kirbely LT, Kallehave F, Jorgensen LN (2005) Smoking is a risk factor for incisional hernia. Arch Surg 140:119–123
William RF, Martin DF, Mulrooney MT, Voeller GR (2008) Intraperitoneal modification of the Rives-Stoppa repair for large incisional hernias. Hernia 12:141–145
Bellon JM, Duran HJ (2008) Factores biológicos en la génesis de la hernia incisional. Cir Esp 83(1):3–7
Klinge V, Si ZY, Zheng H, Schumpelick V, Bhardway RS, Klosterhalfen B (2000) Abnormal collagen I to III distribution in the skin of patients with incisional hernia. Eur Surg Res 32:43–48
Penttinen R, Gronroos S (2008) Mesh repair of common abdominal hernias: a review on experimental and clinical studies. Hernia 12:337–344
Si Z, Rhanjit B, Rosch R et al (2002) Impaired balance of type I and III procollagen MRNA in cultured fibroblasts of patients with incisional hernia. Surgery 131:324–331
Cannon DJ, Casteel L, Read RL (1984) Abdominal aortic aneurysm. Leriche’s syndrome, inguinal herniation and smoking. Arch Surg 119:387–389
Peirolini D, Mazzucchi E (2001) Abdominal wall hernia repair of incisional hernia in kidney transplant patients. A technique with onlay polypropylene mesh. Hernia 5:31–35
Gomez R, Hidalgo M, Marques E, Marin LM, Loinaz C, Gonzalez F, Moreno E (2001) Incidence and predisposing factors for incisional hernia in patients with liver transplantation. Hernia 5–4:173–176
Guzman Valdivia G, Zagg I (2001) Abdominal wall hernia repair in patients with chronic renalfailure and a dialysis catheter. Hernia 5:9–11
van’t Riet M, Steyerberg EV, Nellensteyn J, Bonjer HJ, Jeekel J (2002) Meta-analysis of techniques for closure of midline abdominal Incision. Br J Surg 89:1350–1356
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hidalgo, M.P., Ferrero, E.H., Ortiz, M.A. et al. Incisional hernia in patients at risk: can it be prevented?. Hernia 15, 371–375 (2011). https://doi.org/10.1007/s10029-011-0794-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-011-0794-0