Is prophylactic mesh closure effective to decrease the incidence of incisional hernia after laparotomy in colorectal surgery?

BACKGROUND: few studies have studied prophylactic mesh closure after laparotomy for colorectal surgery. METHODS: a retrospective cohort study was performed to compare patients with and without prophylactic mesh closure after open colorectal surgery. RESULTS: 309 patients were included from January 2014 to December 2016. Prophylactic mesh closure was performed in 98 patients (31.7%). After a mean follow-up of 21.7 months, incisional hernia was developed in 9 and 54 patients in the group with and without mesh respectively (9.2% vs. 25.7%, OR = 0.3, p = 0.001). In the multivariate Cox model prophylactic mesh closure was associated with a protective effect on incisional hernia development with a Hazard Ratio of 0.46 (p = 0.033). Surgical site infection was more frequent in the mesh group (19.4% vs. 9.5%, OR = 2.3, p = 0.015). CONCLUSIONS: prophylactic mesh closure is effective to decrease the incidence of incisional hernia after colorectal surgery.

Trocar-site incisional hernia after laparoscopic colorectal surgery: a significant problem? Incidence and risk factors from a single-center cohort.

BACKGROUND: Trocar-site incisional hernia (TSIH) after laparoscopic surgery has been scarcely studied. TSIH incidence and risk factors have never been properly studied for laparoscopic colorectal surgery. METHODS: A retrospective analytic study in a tertiary hospital was performed including patients who underwent elective laparoscopic colorectal surgery between 2014 and 2016. Clinical and radiological TSIH were analyzed. RESULTS: 272 patients with a mean age of 70.7 years were included. 205 (75.4%) underwent surgery for a malignant disease. The most common procedure was right colectomy (108 patients, 39.7%). After a mean follow-up of 30.8 months 64 (23.5%) patients developed a TSIH. However, only 7 out of 64 (10.9%) patients with a TSIH underwent incisional hernia repair. That means that 2.6% of all the patients underwent TSIH repair. 44 (68.8%) patients had TSIH in the umbilical Hasson trocar. In the multivariate analysis, the existence of an umbilical Hasson trocar orifice was the only statistically significant risk factor for TSIH development. CONCLUSIONS: Incidence of TSIH was high, although few patients underwent incisional hernia repair. Most TSIH were observed in the umbilical Hasson trocar, which was the only risk factor for TSIH development in the multivariate analysis. Efforts should be addressed to avoid TSIH in the umbilical Hasson trocar.

Extraction-site incisional hernia after laparoscopic colorectal surgery: should we carry out a study about prophylactic mesh closure?

BACKGROUND: Prophylactic mesh closure has only scarcely been studied to avoid extraction-site incisional hernia after laparoscopic colorectal surgery. The aim was to analyze extraction-site incisional hernia incidence after laparoscopic colorectal surgery to assess if prophylactic mesh closure should be studied. METHODS: A retrospective analytic cohort study was conducted in patients who had undergone laparoscopic colorectal surgery with an extraction-site incision. Extraction-site incisional hernia was diagnosed during clinical examination or imaging. Risk factors for extraction-site incisional hernia were analyzed. RESULTS: Two hundred and twenty-five patients were included. More than 80% of the patients had a malignant disease. Ninety-two patients (40.9%) underwent right colectomy. Midline extraction-site incision was used in 86 (38.2%) patients. After a mean follow-up of 2.4 years, 39 (17.3%) patients developed an extraction-site incisional hernia. Midline extraction-site incision was associated with incisional hernia when compared to transverse and Pfannenstiel incision (39.5% vs. 3.6%, OR 17.5, p < 0.001). Surgery to repair an extraction-site incisional hernia was also more frequent in the group of patients with a midline incision (10.5% vs. 1.4%, OR 8.0, p = 0.002). In the multivariate analysis, incisional hernia was associated with body mass index, high blood pressure, and midline incision. CONCLUSIONS: Extraction-site incisional hernia was mainly related to midline incisions; therefore, midline incision should be avoided whenever possible. Studying prophylactic mesh closure for Pfannesnstiel or transverse incisions is needless, as these incisions have a low incisional hernia risk.

Hipertexto, jogo educativo e simulação sobre oxigenoterapia: avaliando sua utilização junto a acadêmicos de enfermagem / Hypertext, educational game, and simulation concerning oxygen therapy and itheir use by nursing students. An exploratory study / Hipertexto, juego educativo y simulación sobre oxigenoterapia: evaluando su utilización ante académicos de enfermería

A criação de objetos educacionais digitais para o ensino de Enfermagem tem envolvido uma equipe de docentes e alunos da Universidade Federal do Rio Grande do Sul, abrangendo desde o seu desenho pedagógico e tecnológico até a sua avaliação. Este estudo de cunho quantitativo teve como objetivo verificar a adequação dos objetos hipertexto, jogo educativo e simulação sobre oxigenoterapia junto aos acadêmicos da quarta etapa do Curso. A amostra constituiu-se de 44 alunos, que responderam a um questionário nos períodos de 2005/1 e 2005/2, após a aprovação do projeto de pesquisa pelo Comitê de Ética em Pesquisa. Os dados, analisados estatisticamente mediante o uso do software SPSS 13.5, apontaram que o uso de material digital foi positivo e reforçou a importância do aluno como participante ativo no processo de aprendizagem.

The creation of digital learning objects for the teaching of Nursing has involved a staff of professors and undergraduate students at the Universidade Federal do Rio Grande do Sul, from their pedagogical and technological design up to their evaluation. The purpose of the present quantitative study was to verify the adequacy of the objects hypertext, educational game, and simulation concerning oxygen therapy, according to the nursing students at the fourth stage of the undergraduate course. Forty-five students, who answered a questionnaire in the periods of 2005/1 and 2005/2, after the approval of the research project by the Researche Ethical Committee, constituted the sample. The data, statistically analyzed by using the software SPSS 13.5, revealed that the use of digital material was positive and reinforced the student's importance as active participants in the learning process.

La creación de objetos educativos digitales para la enseñanza de Enfermería ha involucrado a un equipo de docentes y alumnos de la Universidade Federal do Rio Grande do Sul, abarcando desde su diseño pedagógico y tecnológico hasta su evaluación. Este estudio de carácter cuantitativo tuvo como objetivo verificar la adecuación de los objetos hipertexto, juego educativo y simulación sobre oxigenoterapia ante los académicos de la cuarta etapa de la Carrera. La muestra se constituye de 44 alumnos que han rellenado un cuestionario en los periodos de 2005/1 y 2005/2, tras la aprobación del proyecto de investigación por el Comité de Ética en Pesquisa. Los datos, analizados estadísticamente por medio del uso del software SPSS 13.5, revelaron que el uso de material digital fue positivo y reforzó la importancia del alumno como participante activo en el proceso de aprendizaje.