Page 349 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

could not be performed. The results of cohort studies and non-randomized trials are compared with a generalized linear model, to determine the yearly recurrence risk for every technique. The surgical treatment options could broadly be divided into: open techniques without mesh; open techniques with mesh; and laparoscopic techniques with mesh. The open techniques with mesh augmentation performed best in terms of recurrence rates. Comparing individual techniques on yearly recurrence risk showed the best results for open repair with mesh in the sublay position.
In Chapter 9, the recommendations of the EHS for reporting outcomes of abdominal wall surgery can be found. It is recommended to use existing standards and statements available for the type of study that is being reported, i.e. the CONSORT, TREND, STROBE and PRISMA statements. Furthermore, recommendations are made to use standard de nitions and classi cations relating to hernia variables and treatment, and clear terminology proposed by the EHS and EuraHS. Likewise, the use of the validated Clavien-Dindo classi cation to report complications is recommended. An important proposal is to use‘time-to-event analysis’to report data on‘freedom-of-recurrence’rather than the use of recurrence rates, since this is more sensitive and accounts for patients lost to follow-up.
In Chapter 10, synthetic, composite, and biological meshes are compared in terms of adhesion formation and incorporation after 90 days in an animal model. The polyester composite mesh (Parietex composite®) demonstrated the best long-term results, with good incorporation and very little adhesion formation. The best performing biological mesh was non-crosslinked Strattice®, with very little adhesion formation, but only moderate incorporation.
Chapter 11 describes the implanting and comparing of several synthetic, composite, and biological meshes in a contaminated environment animal model. Polypropylene-based (Parietene®, Parietene composite® and Sepramesh®), condensed polytetra uoroethylene (c-PTFE, Omyramesh®) synthetic and non-crosslinked biological (Strattice®) meshes developed none or very few mesh infections. Adhesion formation after 90 days was very slight with the biological mesh Strattice®, followed by the synthetic meshes Parietene composite® and Omyramesh®. However, incorporation of the biological mesh Strattice® was very poor after 90 days.
In Chapter 12, the cellular immune responses to the synthetic meshes investigated in Chapter 11 are examined. All meshes induced the in ux of
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