Page 110 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 5
Statement
No recommendation can be given on the use of postoperative abdominal binders due to lack of data on their e ect on incisional hernias or burst abdomen rates.
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no
Postoperative restriction of activity
No prospective studies were found on the restriction of physical activity after abdominal incisions. Nevertheless, it is advocated by some surgeons in order to decrease the risk of incisional hernias, but there is no consensus on the level or the duration of the restriction(87). Postoperative restriction might have an adverse impact on the return to normal activity and delay the return to work.
Statement
No recommendation can be given on routine restriction of activity after abdominal surgery due to lack of data on the e ect on incisional hernias or burst abdomen rates.
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no
Prophylactic mesh augmentation
Three Systematic reviews on the topic were found(24, 39, 104).
1. Nachappian et al.(39) did not assess of the quality of the individual studies and included non published data. Therefore this review did
not qualify for inclusion in this guideline.
2. The systematic review by Bhangu et al.(24) is of High Quality and
o ers a good and extensive evaluation of the quality of the individual studies included. However, the quality of the non RCTs was usually low and these studies were not be used as evidence for these guidelines.
3. Timmermans et al.(104) published a good meta-analysis on ve RCT’s using polypropylene mesh, including a RCT published in 2013 by Abo-Ryia et al.(105).
One additional RCT published after the review by Timmermans et al.(106) was identi ed. In this RCT, one hundred and sixty patients were included. This is the rst trial on non-selected elective midline laparotomies (with a majority of oncological patients). All the other trials have only included patients deemed
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