title: Incisional hernia in patients at risk: can it be prevented?
abstract: BACKGROUND
  Incisional hernia is a long-term 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 hernia.
  
  
  METHODS
  Seventy-two 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 low-molecular 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/m(2)), 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 cases.
  
  
  RESULTS
  All patients were assessed by a protocol that included interview, examination of the surgical wound, and abdominal CT scan. Follow-up 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.
  
  
  CONCLUSIONS
  Prophylactic use of a low-molecular-weight polypropylene mesh in abdominal surgery may be useful for the prevention of incisional hernia.
authors.affiliation: Hospital Universitario 12 de Octubre, avda de CORDOBA s/n, Madrid, Spain. mhidalgo.hdoc@salud.madrid.org
authors.forename: M P
authors.initials: MP
authors.lastname: Hidalgo
authors.forename: E H
authors.initials: EH
authors.lastname: Ferrero
authors.forename: M A
authors.initials: MA
authors.lastname: Ortiz
authors.forename: J M F
authors.initials: JM
authors.lastname: Castillo
authors.forename: A G
authors.initials: AG
authors.lastname: Hidalgo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006554:Hernia, Umbilical / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012307:Risk Factors; D013526:Surgical Mesh; D013537:Sutures / Q000009:adverse effects; D013997:Time Factors; D014014:Tissue Adhesives / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives