Page 338 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 17
when the closure is with quickly absorbable sutures and trocars exceeding 5 mm in diameter(84, 85). To further prevent IH in high-risk patients, a prophylactic mesh seems a useful option. Ongoing research on the use of prophylactic mesh augmentation of the abdominal wall in high-risk patients is likely to provide high quality evidence regarding the best position of the mesh in the abdominal wall(11). Additionally, research on the improvement of fascial wound healing to prevent IH should be performed. Interesting ideas about the use of stem cells and growth factors are currently being investigated(86-88).
The surgical treatment of IH is complex, and individual patient-, surgical technique-, and mesh-related issues should be addressed for each patient. Every incisional hernia is di erent, and a CT-scan should be used to preoperatively evaluate the dimensions of the hernia, loss of domain, and quality of remaining abdominal wall muscles and tissues. The complexity of hernia repair necessitates a dedicated and certi ed abdominal wall surgeon and surgical team. Many incisional hernia repairs bene t from techniques where planes in the abdominal wall are used or mobilized, which requires in- depth knowledge of the abdominal wall and experience in abdominal wall surgery. To improve evidence-based surgery in hernia repair, an international collaboration should be established, with the involvement of dedicated hernia surgeons in international studies. Only in this manner can high-quality research, with adequate patients numbers, be accomplished. A very important parameter in hernia research is the length and method of follow-up. Patient follow-up should exceed one year, and radiological imaging is essential in establishing recurrence rates. A national, or (preferably) international, registry of hernia patients would be helpful. EuraHS and the Danish Hernia Registry are excellent examples of this, and are used to answer various research questions that require large cohort studies of patients(89-92).
Even for dedicated IH surgeons, it is almost impossible to make an educated selection of a mesh from the hundreds of available types and brands on the market. It is therefore advised that the positive and negative experiences of hernia surgeons should be ‘bundled’ through international collaboration. Research should not be performed on speci c brands of meshes, but rather on generic characteristics of each type of mesh. The initiative of the research group Matthews and Deeken on this subject should be applauded. An interesting concept might be some sort of ‘certi cate of approval’ for a mesh, granted by an international committee of experts from the scienti c societies
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