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Prophylactic meshes in the abdominal wall

Prophylaktische Netze in der Bauchdecke

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Abstract

Background

There is a high incidence of incisional hernias in specific high-risk patient populations. For these patients, the prophylactic placement of mesh during closure of the abdominal wall incision has been investigated in several prospective studies.

Objective

This article aims to summarize and synthetize the currently available evidence on prophylactic meshes in a narrative review.

Materials and methods

Systematic reviews were performed on the use of prophylactic meshes in different indications: midline laparotomies, stoma reversal wounds, and permanent stoma.

Results

High-quality data from randomized trials shows that prophylactic synthetic non-absorbable mesh implantation is safe and effective, both in prevention of incisional hernias after midline laparotomies and during construction of an elective end colostomy. It should be considered in patients with a high risk for incisional hernia development, such as those receiving open abdominal aortic aneurysm, obesity, or colorectal cancer surgery. It is strongly recommended for construction of an elective permanent end colostomy. For midline laparotomies, both the retromuscular and onlay positions of a prophylactic mesh seem equally effective and safe. For parastomal hernia prevention, only the retromuscular prophylactic mesh and its use for end colostomies has been proven to be effective and safe. No data support the choice of a biological mesh or a synthetic absorbable mesh over a non-absorbable synthetic mesh, even in clean–contaminated surgical procedures. No data yet support the standard use of prophylactic mesh when closing the wound during closure of a temporary stoma.

Conclusion

Prophylactic mesh implantation should be standard of care during construction of an elective end colostomy and will become standard of care for midline laparotomies in patients at a high risk of incisional hernias.

Zusammenfassung

Hintergrund

Die Inzidenz der Narbenhernie ist in gewissen Risikopopulationen besonders erhöht. Für diese Patienten kann die Implantation eines prophylaktischen Netzes im Rahmen des primären Bauchdeckenverschlusses sinnvoll sein. Diese Hypothese wurde in verschiedenen prospektiven Studien untersucht.

Ziel

Deskriptive Darstellung einer Zusammenfassung der aktuell verfügbaren Evidenz zu prophylaktischen Netzen.

Material und Methoden

Es wurden systematische Reviews zur Anwendung prophylaktischer Netze bei unterschiedlichen Indikationen durchgeführt: mediane Laparotomie, Stomarückverlagerung und primäre Anlage eines permanenten Stomas.

Ergebnisse

Qualitativ hochwertige Daten aus randomisierten Studien zeigen, das synthetisch nichtresorbierbare Netze in prophylaktischer Intention sicher und effektiv in der Prävention von Narbenhernien bei medianer Laparotomie und bei der primären Anlage eines elektiven endständigen Kolostomas sind. Prophylaktische Netze sollten bei Patienten mit erhöhtem Risiko für die Entstehung einer Narbenhernie implantiert werden. Dies sind Patienten mit offener Versorgung eines Bauchaortenaneurysmas (AAA), Adipositaschirurgie und onkologische kolorektale Eingriffe. Für den Verschluss der Medianlaparotomie scheinen prophylaktische Netze in retromuskulärer sowie Onlay-Position gleichwertig effektiv und sicher zu sein. Zur Prävention der parastomalen Hernie ist das retromuskuläre Netz bei endständigem Kolostoma als effektiv und sicher erwiesen. Die Datenlage unterstützt nicht die Anwendung biologischer oder synthetisch-resorbierbarer Netze, auch nicht bei kontaminierten Eingriffen. Es sind keine validen Daten zu prophylaktischen Netzen im Rahmen der Rückverlagerung eines Stomas verfügbar.

Schlussfolgerung

Prophylaktische Netze sollten standardmäßig bei der primären Anlage eines elektiven endständigen Kolostomas implantiert werden. Es ist davon auszugehen, dass bei Risikopatienten die Implantation eines prophylaktischen Netzes im Rahmen des Primärverschlusses der medianen Laparotomie zum Standard werden wird.

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References

  1. Hartog D den, Dur A, Kamphuis A et al (2009) Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias. Hernia 13:45–48

    Article  Google Scholar 

  2. Fink C, Baumann P, Wente M et al (2013) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101:51–54

    Article  PubMed  Google Scholar 

  3. Bosanquet D, Ansell J, Abdelrahman T et al (2015) Systematic review and meta-regression of factors affecting midline Incisional hernia rates: analysis of 14 618 patients. PLoS ONE 10:1–18

    Article  Google Scholar 

  4. Alnassar S, Bawahab M, Abdoh A et al (2012) Incisional hernia postrepair of abdominal aortic occlusive and aneurysmal disease: five-year incidence. Vascular 20:273–277

    Article  PubMed  Google Scholar 

  5. Henriksen N, Helgstrand F, Vogt K et al (2013) Risk factors for incisional hernia repair after aortic reconstructive surgery in a nationwide study. J Vasc Surg 57:1524–1530

    Article  PubMed  Google Scholar 

  6. Pereira A, Pera M, Grande L (2013) Elevada incidencia de hernia incisional tras reseccion abierta y laparoscopica por cancer colorrectal. Cir Esp 1:5–10

    Google Scholar 

  7. Claes K, Beckers R, Heindryckx E et al (2014) Retrospective observational study on the incidence of incisional hernias after colorectal carcinoma resection with follow-up CT scan. Hernia 18:797–802

    Article  CAS  PubMed  Google Scholar 

  8. Gillion J‑F, Sanders D, Miserez M et al (2016) The economic burden of incisional ventral hernia repair: a multicentric cost analysis. Hernia. doi:10.1007/s10029-016-1480-z.

    Google Scholar 

  9. Helgstrand F, Rosenberg J, Kehlet H et al (2012) Reoperation versus clinical recurrence rate after ventral hernia repair. Ann Surg 256:955–958

    Article  PubMed  Google Scholar 

  10. Muysoms F, Antoniou S, Bury K et al (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24

    Article  CAS  PubMed  Google Scholar 

  11. Pans A, Elen P, Desaive C et al (1998) Long-term results of Polyglactin mesh for the prevention of incisional hernias in obese patients. World J Surg 22:479–483

    Article  CAS  PubMed  Google Scholar 

  12. Strzelczyk J, Czupryniak L, Loba J et al (2002) The use of polypropylene mesh in midline incision closure following gastric by-pass surgery reduces the risk of postoperative hernia. Langenbecks Arch Surg 387:294–297

    Article  PubMed  Google Scholar 

  13. Strzelczyk J, Szymański D, Nowicki M et al (2006) Randomized clinical trial of postoperative hernia prophylaxis in open bariatric surgery. Br J Surg 93:1347–1350

    Article  CAS  PubMed  Google Scholar 

  14. Rogers M, McCarthy R, Earnshaw J (2003) Prevention of incisional hernia after aortic aneurysm repair. Eur J Vasc Endovasc Surg 26:519–522

    Article  CAS  PubMed  Google Scholar 

  15. Bevis P, Windhaber R, Lear P et al (2010) Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. Br J Surg 97:1497–1502

    Article  CAS  PubMed  Google Scholar 

  16. Gutiérrez PC de la, Medina AC, Domínguez-Adame E et al (2003) Primary closure of laparotomies with high risk of incisional hernia using prosthetic material: analysis of usefulness. Hernia 7:134–136

    Article  Google Scholar 

  17. El-Khadrawy O, Moussa G, Mansour O et al (2009) Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients. Hernia 13:267–274

    Article  CAS  PubMed  Google Scholar 

  18. Abo-Ryia M, El-Khadrawy O, Abd-Allah H (2013) Prophylactic preperitoneal mesh placement in open bariatric surgery: a guard against incisional hernia development. Obes Surg 23:1571–1574

    Article  PubMed  Google Scholar 

  19. Caro-Tarrago A, Olona CC, Jimenez SA et al (2014) Prevention of Incisional hernia in midline laparotomy with an onlay mesh: a randomized clinical trial. World J Surg 38:2223–2230

    Article  CAS  PubMed  Google Scholar 

  20. Sarr M, Hutcher N, Snyder S et al (2014) A prospective, randomized, multicenter trial of Surgisis Gold, a biologic prosthetic, as a sublay reinforcement of the fascial closure after open bariatric surgery. Surgery 156:902–908

    Article  PubMed  Google Scholar 

  21. Bali C, Papakostas J, Georgiou G et al (2015) A comparative study of sutured versus bovine pericardium mesh abdominal closure after open abdominal aortic aneurysm repair. Hernia 19:267–271

    Article  CAS  PubMed  Google Scholar 

  22. García-Ureña M, López-Monclús J, Blázquez Hernando L et al (2015) Randomized controlled trial of the use of a large-pore polypropylene mesh to prevent Incisional hernia in colorectal surgery. Ann Surg 261:875–881

    Article  Google Scholar 

  23. Timmermans L, Eker H, Steyerberg E et al (2015) Short-term results of a randomized controlled trial comparing primary suture with primary glued mesh augmentation to prevent incisional hernia. Ann Surg 261:276–281

    Article  PubMed  Google Scholar 

  24. Muysoms FE, Detry O, Vierendeels T et al (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

    Article  PubMed  Google Scholar 

  25. Llaguna O, Avgerinos D, Nagda P et al (2011) Does prophylactic biologic mesh placement protect against the development of incisional hernia in high-risk patients? World J Surg 35:1651–1655

    Article  CAS  PubMed  Google Scholar 

  26. Kurmann A, Barnetta C, Candinas D et al (2013) Implantation of prophylactic nonabsorbable intraperitoneal mesh in patients with peritonitis is safe and feasible. World J Surg 37:1657–1660

    Article  Google Scholar 

  27. O’Hare JL, Ward J, Earnshaw JJ (2007) Late results of mesh wound closure after elective open aortic aneurysm repair. Eur J Vasc Endovasc Surg 33:412–413

    Article  PubMed  Google Scholar 

  28. Herbert GS, Tausch TJ, Carter PL (2009) Prophylactic mesh to prevent incisional hernia: a note of caution. Am J Surg 197:595–598

    Article  PubMed  Google Scholar 

  29. Hidalgo M, Ferrero E, Ortiz M et al (2011) Incisional hernia in patients at risk: can it be prevented? Hernia 15:371–375

    Article  CAS  PubMed  Google Scholar 

  30. Luijendijk R, Hop W, Tol M van den et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Eng J Med 343:392–398

    Article  CAS  Google Scholar 

  31. Burger J, Luijendijk R, Hop W 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

    PubMed  PubMed Central  Google Scholar 

  32. Schreinemacher M, Vijgen G, Dagnelie P et al (2011) Incisional hernias in temporary stoma wounds: a cohort study. Arch Surg 146:94–99

    Article  PubMed  Google Scholar 

  33. Bhangu A, Fletcher L, Kingdon S et al (2012) A clinical and radiological assessment of incisional hernias following closure of temporary stomas. Surgeon 10:321–325

    Article  PubMed  Google Scholar 

  34. Liu DSH, Banham E, Yellapu S (2013) Prophylactic mesh reinforcement reduces stomal site incisional hernia after ileostomy closure. World J Surg 37:2039–2045

    Article  PubMed  Google Scholar 

  35. Maggiori L, Moszkowicz D, Zappa M et al (2015) Bioprosthetic mesh reinforcement during temporary stoma closure decreases the rate of incisional hernia: a blinded, case-matched study in 94 patients with rectal cancer. Surgery 158:1651–1657

    Article  PubMed  Google Scholar 

  36. Bhangu A, Futaba K, Patel A et al (2014) Reinforcement of closure of stoma site using a biological mesh. Tech Coloproctol 18:305–308

    Article  CAS  PubMed  Google Scholar 

  37. Barneveld K van, Vogels R, Beets G et al (2014) Prophylactic intraperitoneal mesh placement to prevent incisional hernia after stoma reversal: a feasibility study. Surg Endosc 28:1522–1527

    Article  PubMed  Google Scholar 

  38. Jänes A, Cengiz Y, Israelsson L (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91:280–282

    Article  PubMed  Google Scholar 

  39. Jänes A, Cengiz Y, Israelsson L (2009) Preventing parastomal hernia with a prosthetic mesh: a 5‑year follow-up of a randomized study. World J Surg 33:118–121

    Article  PubMed  Google Scholar 

  40. Hammond T, Huang A, Prosser K et al (2008) Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia 12:475–481

    Article  CAS  PubMed  Google Scholar 

  41. Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J (2009) Randomized, controlled, prospective trial of the use of mesh to prevent parastomal hernia. Ann Surg 249:583–587

    Article  PubMed  Google Scholar 

  42. López-Cano M, Lozoya-Trujillo R, Quiroga S et al (2012) Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial. Hernia 16:661–667

    Article  PubMed  Google Scholar 

  43. Fleshman J, Beck D, Hyman N et al (2014) A prospective, multicenter, randomized, controlled study of non-cross-linked porcine acellular dermal matrix fascial sublay for parastomal reinforcement in patients undergoing surgery for permanent abdominal wall ostomies. Dis Colon Rectum 57:623–631

    Article  PubMed  Google Scholar 

  44. Târcoveanu E, Vasilescu A, Cotea E et al (2014) Parastomal hernias – clinical study of therapeutic strategies. Chirurgia (Bucur) 109:179–184

    Google Scholar 

  45. Lambrecht R, Larsen G, Reiertsen O et al (2015) Prophylactic mesh at end-colostomy construction reduces parastomal hernia rate: a randomised trial. Colorectal Dis 17:191–197

    Article  Google Scholar 

  46. Vierimaa M, Klintrup K, Biancari F et al (2015) Prospective, randomized study on the use of a prosthetic mesh for prevention of parastomal hernia of permanent colostomy. Dis Colon Rectum 58:943–949

    Article  PubMed  Google Scholar 

  47. Brandsma H, Hansson B, Aufenacker T et al (2015) Prophylactic mesh placement to prevent parastomal hernia, early results of a prospective multicentre randomized trial. Hernia. doi:10.1007/s10029-015-1427-9.

    PubMed  Google Scholar 

  48. López-Cano M, Serra-Aracil X, Mora L et al (2016) Preventing parastomal hernia using a modified Sugarbaker technique with composite mesh during laparoscopic abdominoperineal resection. Ann Surg 8. doi:10.1097/sla.0000000000001684

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Authors and Affiliations

  1. Department for General, Thoracic and Cardiovascular Surgery, AZ Maria Middelares Dienst Algemene Heelkunde, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium

    F. E. Muysoms

  2. Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany

    U. A. Dietz

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Correspondence to F. E. Muysoms.

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F. E. Muysoms and U. A. Dietz state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

The supplement containing this article is not sponsored by industry.

Additional information

The German version of this article can be found under doi:10.1007/s00104-016-0245-7

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Muysoms, F.E., Dietz, U.A. Prophylactic meshes in the abdominal wall. Chirurg 88 (Suppl 1), 34–41 (2017). https://doi.org/10.1007/s00104-016-0229-7

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  • DOI: https://doi.org/10.1007/s00104-016-0229-7

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