Page 179 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

prospective trial has been conducted recently to evaluate their e ectiveness in LIH repair and showed good results regarding mesh infection but a recurrence rate comparable to classic CST without mesh reinforcement(62). The ideal mesh for complex hernia surgery has still not been found and further research should be focus on this.
Finally, patient characteristics such as BMI, age and infection grade were often not described in the included studies and this could cause heterogeneity between groups. We tried to adjust for this limitation by excluding small series. However, this still poses a problem in this review and until new (randomized) trials become available the outcomes of this review should be interpreted critically.
Conclusion
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Research on the treatment of LIH is challenging. LIH must be considered a separate category of incisional hernia, posing more problems than the smaller variety. Because of the high incidence of LIH and possibly also by the lack of centers for this complex pathology many di erent approaches have been proposed and are applied in daily practice until now. This heterogeneity in surgical care makes any validation of techniques di cult. To make results more comparable for future research, a widely accepted classi cation of hernias and repair techniques is needed. A global online registration system for all hernia repair has been developed and launched (EuraHS)(98).
Although available literature regarding LIH repair is relatively scarce, we feel that some of the limitations as previously discussed were adjusted for or reduced in this review due to its design and the statistics used. In this review it was observed that LIH repair with mesh reinforcement is superior with regards to long-term recurrence. Based on available literature sublay repair for LIH seems the preferred techniques it is already implemented widely and displayed good recurrence rates and yearly recurrence hazards. For all techniques increased postoperative complications were reported compared to smaller IH repair. IH repair, and especially LIH repair, is a surgical challenging procedure and in our opinion should be performed by specialists only.
Review treatment large IH
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