Page 334 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 17
have been developed, and promising results in terms of reduced wound infection and necrosis, have been described(30-33). In patients with a large IH, lateral migration of the rectus muscles in conjunction with ank muscle contraction, leads to a progressive decrease in the volume of the abdominal cavity and worsening protrusion of the viscera. Repositioning the viscera in a sti abdominal cavity can lead to decreased perfusion of the intestine and elevation of the diaphragm, which in turn can lead to ventilatory di culties – and rarely, abdominal compartment syndrome(26, 34). The use of preoperative pneumoperitoneum or botox might be indicated in some cases, although evidence is limited(35-38).
These results are in accordance with the results of reviews and meta- analyses on the subject for IH of all sizes(25, 39, 40). However, all authors report the same problem: the heterogeneity of the studies. Little evidence is available from RCTs on the subject of IH repair, and clear de nitions of mesh positions, techniques, and outcome parameters are lacking, with substantial research aws both methodologically and statistically. To improve the evidence-base for IH-surgery, the European Hernia Society Working Group has developed a classi cation for IH which takes in account the location, size, and possible recurrence of the IH(41). This classi cation system has, since its introduction in 2009, been widely accepted and used in scienti c publications regarding IH. However, a solid comparison of research on abdominal wall surgery has remained elusive, due to the strong heterogeneity of reported study population characteristics and outcome measurements. To address this issue, improve research on hernia repair, and enable comparison of the literature, the EHS initiated a consensus meeting, and recommendations were duly formulated. Besides true recurrence, bulging is also an important adverse e ect of abdominal wall repair, and the incidence of this is likely to have increased with the rise in laparoscopic hernia repairs(42). Clinical distinction between recurrence and bulging of mesh, is di cult(42-44). Di erentiation is therapeutically irrelevant in symptomatic patients, because in both conditions surgical repair is indicated. Asymptomatic patients, however, do not require repair in the case of mesh-bulging, except for cosmetic reasons, and a watchful waiting approach seems justi ed in such cases(42).
The subject of a large part of the research on the treatment of IH is the search for the ideal mesh. Currently, a wide variety of synthetic and biological meshes are available on the market, complicating the selection of an
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