Incisional Hernia
Conditions
Brief summary
The use of different types of mesh at different sites in prevention of incisional hernia after various abdominal incision versus primary abdominal suturing.
Detailed description
The burden of incisional hernia after abdominal exploration has raised the question if a prophylactic mesh placement during abdominal wall closure is of benefit. The reported rate of incisional hernia after abdominal incisions varies from 4.2% up to a calculated risk of 73%. The impact on quality of life and annual health care costs has motivated various groups to research ways to decrease the rate of incisional hernia by optimizing the technique of abdominal wall closure. One of the crucial risk factors of the genesis of incisional hernias is the malfunction of collagen synthesis. Other main risk factors are found to be obesity, steroid therapy, malnutrition, nicotine abuse, and other connective tissue diseases. Since German physician Theodor Billroth's first suggested use of prosthetic material to close the hernia defect in 1890, continued interest lead to the development of a variety of surgical meshes and techniques for suture and mesh reinforcement to prevent incisional hernia . Overtime, RCTs have demonstrated the effectiveness of the use of prophylactic mesh in the prevention of incisional hernia. While surgeons world over use different techniques of positioning mesh in the prophylactic mesh repair (PMR) such as the Onlay, Sublay and Intraperitoneal positions, which can be associated with a high incidence of complications such as the postoperative seroma.
Interventions
PROCEDUREprophylactic mesh repair at different sites for prevention of incisional hernia after various abdominal incision versus primary abdominal suturing
before closure of the abdominal layers prophylactic mesh will be used for prevention of incisional hernia. another patient with abdominal incision , primary closure of abdominal layer will occur.
Sponsors
Assiut University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* informed consent * patient age: ≥ 18 years * patients undergoing elective or urgent open abdominal surgical procedure regardless of benign or malignant disease
Exclusion criteria
* age \<18 years * navel site infection * pregnancy * expected survival \<12 month * previous intra abdominal mesh placement
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| early wound complications | 1 month | wound infection (with or without removal of the mesh) ,wound necrosis , wound hematoma |
| late wound complications | 1 month | post operative incisional hernia, wound infection (with or without removal of the mesh) wound necrosis wound hematoma. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| complication rate | intraoperative complications will be recorded immediately after finishing the operation | major bleeding bowel injury |
| incidence of incisional hernia | 12 month | the incidence of incisional hernia, either symptomatic or asymptomatic in the mesh and suture-only groups. |
Countries
Egypt
Contacts
Primary Contactkerolos samer, Reside doctor
Backup ContactAhmed Soliman, prof ofsurgery
Outcome results
None listed