Skip to main content

Advertisement

SpringerLink
Log in

Hernia prevention: practice patterns and surgeons’ attitudes about abdominal wall closure and the use of prophylactic mesh

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

The penetration of hernia prevention techniques into surgical practice remains unknown.

Methods

A survey about knowledge/attitudes on hernia prevention was sent to the members of hernia societies.

Results

The 497 respondents were mostly from the US (47%) or Europe (40%). Most reported practicing, but not measuring their suture-to-wound length closure of > 4:1 (63%) and practicing but not measuring the number of stitches (58%). Reasons for not using short stitch closure were: does not apply to patient population (19%), not familiar enough with methods to correctly execute (25%), takes too long (13%), not reimbursed (4%), concerned about closure-related complications (27%), and other (22%). Regarding prophylactic mesh, respondents stated they were not familiar with literature (11%), familiar with literature but would not use (24%), familiar with literature and interested in use (45%), familiar with literature and using (15%), and other (5%).

Conclusions

There appears to be some application of hernia prevention principles related to fascial closure; however, the use of prophylactic mesh still appears to be controversial.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cobb WS, Kercher KW, Heniford BT (2005) Laparoscopic repair of incisional hernias. Surg Clin North Am 85:91–103. https://doi.org/10.1016/j.suc.2004.09.006 ix.

    Article  PubMed  Google Scholar 

  2. Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71

    Article  CAS  Google Scholar 

  3. Osther PJ, Gjode P, Mortensen BB, Mortensen PB, Bartholin J, Gottrup F (1995) Randomized comparison of polyglycolic acid and polyglyconate sutures for abdominal fascial closure after laparotomy in patients with suspected impaired wound healing. Br J Surg 82:1080–1082

    Article  CAS  PubMed  Google Scholar 

  4. Israelsson LA, Jonsson T (1996) Incisional hernia after midline laparotomy: a prospective study. Eur J Surg 162:125–129

    CAS  PubMed  Google Scholar 

  5. Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183. https://doi.org/10.1007/s10029-011-0879-9

    Article  CAS  PubMed  Google Scholar 

  6. Lopez-Cano M, Brandsma HT, Bury K, Hansson B, Kyle-Leinhase I, Alamino JG, Muysoms F (2017) Prophylactic mesh to prevent parastomal hernia after end colostomy: a meta-analysis and trial sequential analysis. Hernia 21:177–189. https://doi.org/10.1007/s10029-016-1563-x

    Article  CAS  PubMed  Google Scholar 

  7. Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Janes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, Lopez-Cano M, Maggiori L, Mandala V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Smietanski M, Szczepkowski M, Stabilini C, Muysoms FE (2017) European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia. https://doi.org/10.1007/s10029-017-1697-5

    Article  PubMed  Google Scholar 

  8. Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Janes A, Jeekel J, Lopez-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Smietanski M, Venclauskas L, Berrevoet F, European Hernia S (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24. https://doi.org/10.1007/s10029-014-1342-5

    Article  CAS  PubMed  Google Scholar 

  9. Muysoms FE, Detry O, Vierendeels T, Huyghe M, Miserez M, Ruppert M, Tollens T, Defraigne JO, Berrevoet F (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. https://doi.org/10.1097/SLA.0000000000001369

    Article  PubMed  Google Scholar 

  10. Jairam AP, Timmermans L, Eker HH, Pierik R, van Klaveren D, Steyerberg EW, Timman R, van der Ham AC, Dawson I, Charbon JA, Schuhmacher C, Mihaljevic A, Izbicki JR, Fikatas P, Knebel P, Fortelny RH, Kleinrensink GJ, Lange JF, Jeekel HJ, Group PT (2017) Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet 390:567–576. https://doi.org/10.1016/S0140-6736(17)31332-6

    Article  PubMed  Google Scholar 

  11. Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FP, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386:1254–1260. https://doi.org/10.1016/S0140-6736(15)60459-7

    Article  PubMed  Google Scholar 

  12. Israelsson LA (2015) Abdominal incision closure: small but important bites. Lancet 386:1216–1218. https://doi.org/10.1016/S0140-6736(15)60687-0

    Article  PubMed  Google Scholar 

  13. Janes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33:118–121. https://doi.org/10.1007/s00268-008-9785-4 (discussion 122–113)

    Article  PubMed  Google Scholar 

  14. Israelsson LA, Millbourn D (2013) Prevention of incisional hernias: how to close a midline incision. Surg Clin North Am 93:1027–1040. https://doi.org/10.1016/j.suc.2013.06.009

    Article  PubMed  Google Scholar 

  15. Williams ZF, Tenzel P, Hooks WB 3rd, Hope WW (2017) Suture to wound length ratio in abdominal wall closure: how well are we doing? Hernia 21:869–872. https://doi.org/10.1007/s10029-017-1667-y

    Article  CAS  PubMed  Google Scholar 

  16. Muysoms FE, Jairam A, López-Cano M, Śmietański M, Woeste G, Kyle-Leinhase I, Antoniou SA, Köckerling F, Köckerling BSG, Antoniou F, Fortelny S, Granderath R, Heiss FA, Mayer M, Miserez F, Montgomery M, Morales-Conde A, Muysoms S, Petter-Puchner F, Pointner A, Smart R, Smietanski N, Stechemesser M B (2016) Prevention of incisional hernias with biological mesh: a systematic review of the literature. Front Surg. https://doi.org/10.3389/fsurg.2016.00053

    Article  PubMed  PubMed Central  Google Scholar 

  17. Walhberg A, Poom L (2015) An empirical test of nonresponse bias in internet surveys. Basic Appl Soc Psychol 37:336–347. https://doi.org/10.1080/01973533.2015.1111212

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

    J. P. Fischer

  2. Department of Surgery, University of California, San Francisco, CA, USA

    H. W. Harris

  3. Abdominal Wall Surgery Unit, Department of Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    M. López-Cano

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

    W. W. Hope

Authors
  1. J. P. Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. W. Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. López-Cano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. W. Hope
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. W. Hope.

Ethics declarations

Conflict of interest

Dr. Hope declares the following potential conflicts of interest not directly related to the submitted work: has consulted for CR Bard/Davol, served as a speaker for Bard, WL Gore and Intuitive Surgical, and has received research funding from Bard and Gore. Dr. Fischer declares the following potential conflicts of interest not directly related to the submitted work: has consulted for Bard, WL Gore, and Allergan. Dr. López-Cano declares the following potential conflicts of interest not directly related to the submitted work: has received consultant fees from Bard, WL Gore, and B. Braun. Dr. Harris declares no conflict of interest.

Ethical approval

This study was deemed exempt by our Institutional Review Board.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained by all survey participants.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fischer, J.P., Harris, H.W., López-Cano, M. et al. Hernia prevention: practice patterns and surgeons’ attitudes about abdominal wall closure and the use of prophylactic mesh. Hernia 23, 329–334 (2019). https://doi.org/10.1007/s10029-019-01894-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-019-01894-z

Keywords

Search

Navigation