Page 161 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Introduction
Incisional hernia (IH) is one of the most frequent complications after abdominal surgery with an incidence up to 20%(1-3), and in high risk patients incidences over 35% have been reported (4, 5). In the United States, 4 to 5 million abdominal surgeries are performed every year which means that a number as high as 500.000 IH will develop annually. Within this group, a speci c subcategory of patients with large incisional hernia (LIH) can be identi ed. The incidence of LIH is rising due to an increase in survival of intra-abdominal catastrophes and infections(6). Of all patients with IH 15-47% have a hernia which can be de ned as a LIH (7). Patients with LIH often experience severe symptoms and associated co-morbidities. Patients with LIH may have complaints of severe back pain, disturbance of ventilatory function, chronic wounds or enterocutaneous stulas, resulting in a major decrease in quality of life and daily activities(6, 8-10).
LIH repair is technically challenging and is associated with a longer hospital stay, impaired wound healing, a higher rate of reoperations and readmissions and increased recurrence rates(7, 11-14). In some cases approximation of the rectus fascia is not possible and the mesh can be used to bridge the defect or additional measures such as component separation or aponeuroplasty must be added. Bridging with the mesh in contact with the viscera increases the risk of postoperative complications such as adhesion formation, bowel obstruction and complicated reinterventions(15, 16). In the last decades laparoscopic LIH repair has been introduced, with an intraperitoneal onlay mesh (IPOM) bridging the defect. Using IPOM, augmentation of the abdominal wall is in most cases not performed and the entire mesh is in contact with the viscera, for which reason composite meshes are most often used to reduce adhesion formation.
Randomized clinical trials have been conducted on the di erent repair techniques of small and medium sized ventral(17-20), but the treatment of LIH has not yet been properly addressed. There is no consensus, based on evidence, regarding the optimal treatment option. The treatment of LIH is in fact a major problem, with associated potentially life-threatening complications. The aim of this study is to identify the best possible technique(s) for LIH repair with regards to recurrence and complication rates.
8
Review treatment large IH
159