Page 119 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

as described by van Ramshorst et al.(142). The EuraHS, European registry for abdominal wall hernias, has developed an online platform for registration and outcome measurement of abdominal wall surgery(140). An additional route in the database on the closure of abdominal wall incisions and for prophylactic mesh augmentation will be provided from 2015 onwards. It is hoped that such a registry database will facilitate the data collection for prospective studies.
Validity of the guidelines
5
Prior to submission of the manuscript the guidelines were evaluated and scored using the AGREE II instrument. Several large multi-centre studies on the closure of abdominal wall incisions are currently on-going. High Quality data on the use of the “small bites” technique in midline incisions, on the closure of laparotomies in emergency and on prophylactic mesh augmentation will be published in the coming years. The Guidelines Development Group has decided to update these guidelines in 2017 and present the results during the 39th Annual Congress of the European Hernia Society in Vienna in May 2017.
Conclusions
To decrease the incidence of incisional hernias it is recommended to utilize a non-midline approach to a laparotomy whenever possible. For elective midline incisions, it is strongly recommended to perform a continuous suturing technique and to avoid the use of rapidly absorbable sutures. It is suggested that the use of a slowly absorbable mono lament suture in a single layer aponeurotic closure technique without separate closure of the peritoneum and using a small bites technique with a SL/WL ratio at least 4/1 is the current recommended method of fascial closure. Currently, no recommendations can be given on the optimal technique to close emergency laparotomy incisions. Prophylactic mesh augmentation appears e ective and safe and can be suggested in high-risk patients like, aortic aneurysm surgery and obese patients.
EHS guidelines
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