Page 114 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 5
lower incisional hernia rate was observed in the mesh group, 2.3 vs 17.7 % (p = 0.014). All other studies published used a polypropylene mesh, most often a small pore/heavy weight mesh: Prolene; Ethicon(107), Premilene; B. Braun(109), no name mentioned(105, 108, 110). Only Caro-Tarrago et al.(106) used a large pore/light weight mesh: Biomesh Light P8; Cousin Biotech.
There is a large variation between the studies on the mesh position for the prophylactic mesh augmentation. Onlay, retro-muscular and pre-peritoneal mesh positioning was performed in two studies each. No studies on the use of intra-peritoneal augmentation with a non absorbable synthetic mesh are reported. Only one study on the use of intra-peritoneal augmentation with an absorbable synthetic mesh is reported(111). The mesh was in all studies xed with sutures to the fascia except for the study of Pans et al.(111) which used no xation. No studies on mesh augmentation with glue or a self- xating mesh are reported.
Statement
No recommendation on the optimal mesh position for prophylactic mesh augmentation can be given due to lack of data.
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no
Statement
No recommendation on the optimal method of mesh xation for prophylactic mesh augmentation can be given due to lack of data.
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no
Statement
No recommendation on the type of mesh for prophylactic mesh augmentation can be given due to lack of data.
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no
Trocar wounds for laparoscopic surgery and single port surgery
Trocar size and trocar type
The rst search for systematic reviews resulted in 5 records(33, 40, 41, 46, 49) and 25 additional records were screened by full text(113-136). Several studies comment on the incidence of trocar-site hernia for various trocar sizes. However the quality of many studies is insu cient and challenge the validity of results.
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