title: The use of an algorithm for prophylactic mesh use in high risk patients reduces the incidence of incisional hernia following laparotomy for colorectal cancer resection.
abstract: OBJECTIVE
  Incisional hernia (IH) after colorectal surgery is highly prevalent. The objective of this study is to assess the utility of an algorithm to decide on mesh augmentation after a midline laparotomy for colorectal resection to prevent IH in high-risk patients.
  
  
  METHODS
  A prospective study was conducted including all patients undergoing a midline laparotomy for colorectal resection between January 2011 and June 2014, after the implementation of a decision algorithm for prophylactic mesh augmentation in selected high-risk patients. Intention-to-treat analyses were conducted between patients in which the algorithm was correctly applied and those in which it was not.
  
  
  RESULTS
  From the 235 patients analysed, the algorithm was followed in 166 patients, the resting 69 cases were used as a control group. From an initial adherence to the algorithm of 40% in the first semester, a 90.3% adherence was achieved in the seventh semester. The incidence of IH decreased as the adherence to the algorithm increased (from 28 to 0%) with a time-related correlation (R2=0.781). A statistically significant reduction in IH incidence was demonstrated in high-risk groups in which the algorithm was correctly applied (10,2 vs. 46,3%; p=0,0001; OR: 7,58;95%; CI: 3,8-15). Survival analysis showed that the differences remained constant during follow-up.
  
  
  CONCLUSIONS
  The implementation of the algorithm reduces the incidence of IH in high-risk patients. The adherence to the algorithm also correlates with a decrease in the incidence of IH.
authors.affiliation: Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Barcelona, España; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Núria
authors.initials: N
authors.lastname: Argudo
authors.affiliation: Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Barcelona, España.
authors.forename: M Pilar
authors.initials: MP
authors.lastname: Iskra
authors.affiliation: Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Barcelona, España; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España; Grupo de Investigación de Cáncer Colorrectal, Instituto Hospital del Mar de Investigaciones Médicas (IMIM) , Barcelona, España.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pera
authors.affiliation: Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Barcelona, España; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Sancho
authors.affiliation: Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Barcelona, España; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España; Grupo de Investigación de Cáncer Colorrectal, Instituto Hospital del Mar de Investigaciones Médicas (IMIM) , Barcelona, España.
authors.forename: Luis
authors.initials: L
authors.lastname: Grande
authors.affiliation: Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España; Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Barcelona, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: López-Cano
authors.affiliation: Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universidad Pompeu Fabra, Barcelona, España. Electronic address: 86664@parcdesalutmar.cat.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Pereira
mesh_terms: D000368:Aged; D000465:Algorithms; D015179:Colorectal Neoplasms / Q000601:surgery*; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D015994:Incidence; D000069290:Incisional Hernia / Q000453:epidemiology / Q000517:prevention & control*; D007813:Laparotomy; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D013526:Surgical Mesh
keywords: Cirugía colorrectal; Colon; Colorectal surgery; Eventración; Hernia incisional; Incisional hernia; Malla profiláctica; Prophylactic mesh