Authors: M P Hidalgo E H Ferrero M A Ortiz J M F Castillo A G Hidalgo
Publish Date: 2011/02/12
Volume: 15, Issue: 4, Pages: 371-375
Abstract
Incisional hernia is a longterm 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 herniaSeventytwo 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 lowmolecular 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 casesAll patients were assessed by a protocol that included interview examination of the surgical wound and abdominal CT scan Followup 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
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