Implementing a protocol to prevent incisional hernia in high-risk patients

The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and...

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Autores: Pereira-Rodríguez, José Antonio|||0000-0003-2457-6955, Amador Gil, Sara, Bravo-Salva, Alejandro|||0000-0002-8215-6724, Montcusí-Ventura, B., Sancho Insenser, Joan Josep|||0000-0003-4603-0363, Pera-Román, M., López Cano, Marc|||0000-0001-8885-3726
Formato: artículo
Fecha de publicación:2021
País:España
Recursos:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:292284
Acesso em linha:https://ddd.uab.cat/record/292284
https://dx.doi.org/urn:doi:10.1007/s10029-021-02527-0
Access Level:acceso abierto
Palavra-chave:Abdominal wall closure
Laparotomy closure
Incisional hernia
Small bites
Short stitch
Prophylactic mesh
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spelling Implementing a protocol to prevent incisional hernia in high-risk patientsa mesh is a powerful toolPereira-Rodríguez, José Antonio|||0000-0003-2457-6955Amador Gil, SaraBravo-Salva, Alejandro|||0000-0002-8215-6724Montcusí-Ventura, B.Sancho Insenser, Joan Josep|||0000-0003-4603-0363Pera-Román, M.López Cano, Marc|||0000-0001-8885-3726Abdominal wall closureLaparotomy closureIncisional herniaSmall bitesShort stitchProphylactic meshThe small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes. Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB. A lower number of FD appeared in the M group (OR 0.0692; 95% CI 0.008-0.56; P = 0.01) in 197 operations. After a mean follow-up of 29.23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0.769; 95% CI 0.65-0.91; P < 0.0001). (33) The observed differences persisted after a propensity matching score: FD (OR 0.355; 95% CI 0.255-0.494; P < 0.0001) and IH (OR 0.394; 95% CI 0.24-0.61; P < 0.0001). On comparing suturing techniques by subgroups, both mesh subgroups had better outcomes. PM was the main factor related to the reduction of IH (HR 11.794; 95% CI 4.29-32.39; P < 0.0001). Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used.Universitat Autònoma de Barcelona 22021-01-0120212021-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/292284https://dx.doi.org/urn:doi:10.1007/s10029-021-02527-0reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2922842026-06-06T12:50:31Z
dc.title.none.fl_str_mv Implementing a protocol to prevent incisional hernia in high-risk patients
a mesh is a powerful tool
title Implementing a protocol to prevent incisional hernia in high-risk patients
spellingShingle Implementing a protocol to prevent incisional hernia in high-risk patients
Pereira-Rodríguez, José Antonio|||0000-0003-2457-6955
Abdominal wall closure
Laparotomy closure
Incisional hernia
Small bites
Short stitch
Prophylactic mesh
title_short Implementing a protocol to prevent incisional hernia in high-risk patients
title_full Implementing a protocol to prevent incisional hernia in high-risk patients
title_fullStr Implementing a protocol to prevent incisional hernia in high-risk patients
title_full_unstemmed Implementing a protocol to prevent incisional hernia in high-risk patients
title_sort Implementing a protocol to prevent incisional hernia in high-risk patients
dc.creator.none.fl_str_mv Pereira-Rodríguez, José Antonio|||0000-0003-2457-6955
Amador Gil, Sara
Bravo-Salva, Alejandro|||0000-0002-8215-6724
Montcusí-Ventura, B.
Sancho Insenser, Joan Josep|||0000-0003-4603-0363
Pera-Román, M.
López Cano, Marc|||0000-0001-8885-3726
author Pereira-Rodríguez, José Antonio|||0000-0003-2457-6955
author_facet Pereira-Rodríguez, José Antonio|||0000-0003-2457-6955
Amador Gil, Sara
Bravo-Salva, Alejandro|||0000-0002-8215-6724
Montcusí-Ventura, B.
Sancho Insenser, Joan Josep|||0000-0003-4603-0363
Pera-Román, M.
López Cano, Marc|||0000-0001-8885-3726
author_role author
author2 Amador Gil, Sara
Bravo-Salva, Alejandro|||0000-0002-8215-6724
Montcusí-Ventura, B.
Sancho Insenser, Joan Josep|||0000-0003-4603-0363
Pera-Román, M.
López Cano, Marc|||0000-0001-8885-3726
author2_role author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universitat Autònoma de Barcelona
dc.subject.none.fl_str_mv Abdominal wall closure
Laparotomy closure
Incisional hernia
Small bites
Short stitch
Prophylactic mesh
topic Abdominal wall closure
Laparotomy closure
Incisional hernia
Small bites
Short stitch
Prophylactic mesh
description The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes. Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB. A lower number of FD appeared in the M group (OR 0.0692; 95% CI 0.008-0.56; P = 0.01) in 197 operations. After a mean follow-up of 29.23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0.769; 95% CI 0.65-0.91; P < 0.0001). (33) The observed differences persisted after a propensity matching score: FD (OR 0.355; 95% CI 0.255-0.494; P < 0.0001) and IH (OR 0.394; 95% CI 0.24-0.61; P < 0.0001). On comparing suturing techniques by subgroups, both mesh subgroups had better outcomes. PM was the main factor related to the reduction of IH (HR 11.794; 95% CI 4.29-32.39; P < 0.0001). Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used.
publishDate 2021
dc.date.none.fl_str_mv 2
2021-01-01
2021
2021-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/292284
https://dx.doi.org/urn:doi:10.1007/s10029-021-02527-0
url https://ddd.uab.cat/record/292284
https://dx.doi.org/urn:doi:10.1007/s10029-021-02527-0
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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