Invito alla lettura
Quest’oggi riprendiamo la rubrica di invito alla lettura con un interessante articolo pubblicato di recente sulla rivista Hernia, che parla delle problematiche relative alla prevenzione dell’ernia incisionale, e della chiusura della laparotomia, con punti di vista diversi a seconda delle varie specialità chirurgiche, e della diversa percezione della problematica. L’articolo è stato scritto dal Dr. Garcia-Urena, uno dei nomi più importanti della chirurgia di parete addominale a livello europeo, e merita sicuramente una lettura approfondita.

Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review.

Garcia-Urena MA; POP (Progress On Prevention) Surgical Group.

Hernia. 2021 Feb;25(1):13-22.                                     doi: 10.1007/s10029-020-02348-7.

https://link.springer.com/article/10.1007/s10029-020-02348-7

Abstract

Purpose: Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable morbidity and expenses. In this critical review, the issue is explored by an interdisciplinary group.

Methods: A group of European surgeons encompassing representatives from abdominal wall, vascular, urological, gynecological, colorectal and hepato-pancreatico-biliary surgery have reviewed the occurrence of His in these disciplines.

Results: Incisional hernias are a major public health issue with appreciable morbidity and cost implications. General surgeons are commonly called upon to repair IHs following an initial operation by others. Measures that may collectively reduce the frequency of IH across specialities include better planning and preparation (e.g. a fit patient, no time pressure, an experienced operator). A minimally invasive technique should be employed where appropriate. Our main recommendations in midline incisions include using the 'small bites' suture technique with a ≥ 4:1 suture-to-wound length, and adding prophylactic mesh augmentation in patients more likely to suffer herniation. For off-midline incisions, more research of this problem is essential.

Conclusion: Meticulous closure of the incision is significant for every patient. Raising awareness of the His is necessary in all surgical disciplines that work withing the abdomen or retroperitoneum. Across all specialties, surgeons should aim for a < 10% IH rate.