A panel session at ACS Clinical Congress 2019 examines the evidence behind currently proposed techniques to prevent incisional hernias after midline laparotomy closure, including the use of prophylactic mesh and small-bite 4:1 suture closure.
At the American College of Surgeons (ACS) Clinical Congress 2019, there was an important session in which panelists discussed the advantages and disadvantages of using prophylactic mesh after closure of midline laparotomies to prevent incisional hernias. Ajita Prabhu, MD and Benjamin Poulose, MD moderated the panel session on October 28, 2019.
Heidi Miller, MD of University of New Mexico gave background on risk factors for incisional hernias, which she estimated at 12-13% incidence after closure of a laparotomy. She characterized incisional hernias as “mostly due to technical failures,” including poor wound hemostasis or coagulopathy, too much inflammation of the wound and the associated abnormal collagen structure, and sutures without proper tension. With respect to the latter topic, she described how she likes to view the hernia as a chronic wound, with proliferation and remodeling dependent on proper tension of approximation. She also described modifiable risk factors associated with the patient. Smoking and diabetes affect tissue perfusion, with strong data supporting tissue ischemia associated with smoking. Tissue perfusion greatly affects wound healing, as do modifiable factors that affect inflammation, including proper wound care, nutrition (especially vitamin A intake) and obesity, which is associated with chronic inflammation. Additionally, obesity is also associated with increased risk of wound dehiscence and increased mechanical stress tending to open the wound ...
