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Textbook of Hernia pp 195–199Cite as

The Use of Prophylactic Mesh in the Prevention of Incisional and Parastomal Hernia Repair

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Abstract

Despite improvements in surgical techniques and technology, the incidence of incisional and parastomal hernias remains unacceptably high. Recently a renewed interest in hernia prevention has emerged as improvements in methods of fascial closure and the concept of prophylactic mesh augmentation (PMA) has been applied for high-risk laparotomy closures and in the creations of stomas. As with any prophylactic strategy, evaluation of the risk of the preventive treatment must be carefully weighed against the potential benefit. Outcome measures should not be limited to hernia recurrence but should also include quality of life, infectious complications, and cost. To date, several studies have reported the benefit of PMA in clinical scenarios where patients are at high risk for incisional or parastomal hernias. Further research is required, specifically well-designed comparative effectiveness studies, which assess various techniques and meshes across different patient populations to determine optimal benefit from PMA. Widespread adoption of proven techniques will require well-designed pragmatic research, strong evidence-based guidelines, coding and reimbursement efforts, and education. Risk reduction techniques hold great promise to reduce the incidence of incisional and parastomal hernia.

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Author information

Authors and Affiliations

  1. Department of Surgery, New Hanover Regional Medical Center, 2131 South 17th Street, Wilmington, NC, 28401, USA

    Paul Tenzel M.D. & Daniel Christian M.D.

  2. Division of Plastic and Reconstructive Surgery, Penn Presbyterian Medical Center at the University of Pennsylvania, University of Pennsylvania Health System, 51 N. 39th Street, Philadelphia, PA, 19104, USA

    John Patrick Fischer M.D., M.P.H.

  3. Department of Surgery, New Hanover Regional Medical Center, 2131 South 17th Street, 9025, Wilmington, NC, 28401, USA

    William W. Hope M.D.

Authors
  1. Paul Tenzel M.D.
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  2. Daniel Christian M.D.
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  3. John Patrick Fischer M.D., M.P.H.
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  4. William W. Hope M.D.
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Corresponding author

Correspondence to William W. Hope M.D. .

Editor information

Editors and Affiliations

  1. Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA

    William W. Hope

  2. USC School of Medicine-Greenville, Greenville Health System, Greenville, North Carolina, USA

    William S. Cobb

  3. Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Gina L. Adrales

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Tenzel, P., Christian, D., Fischer, J.P., Hope, W.W. (2017). The Use of Prophylactic Mesh in the Prevention of Incisional and Parastomal Hernia Repair. In: Hope, W., Cobb, W., Adrales, G. (eds) Textbook of Hernia. Springer, Cham. https://doi.org/10.1007/978-3-319-43045-4_26

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  • DOI: https://doi.org/10.1007/978-3-319-43045-4_26

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-43045-4

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