The use of an algorithm for prophylactic mesh use in high risk patients reduces the incidence of incisional hernia following laparotomy for colorectal cancer resection. / Un algoritmo para la colocación de malla profiláctica en pacientes de riesgo reduce la incidencia de hernia incisional tras laparotomía por cáncer colorrectal.

OBJECTIVE: Incisional hernia (IH) after colorectal surgery is highly prevalent. The objective of this study is to assess the utility of an algorithm to decide on mesh augmentation after a midline laparotomy for colorectal resection to prevent IH in high-risk patients. METHODS: A prospective study was conducted including all patients undergoing a midline laparotomy for colorectal resection between January 2011 and June 2014, after the implementation of a decision algorithm for prophylactic mesh augmentation in selected high-risk patients. Intention-to-treat analyses were conducted between patients in which the algorithm was correctly applied and those in which it was not. RESULTS: From the 235 patients analysed, the algorithm was followed in 166 patients, the resting 69 cases were used as a control group. From an initial adherence to the algorithm of 40% in the first semester, a 90.3% adherence was achieved in the seventh semester. The incidence of IH decreased as the adherence to the algorithm increased (from 28 to 0%) with a time-related correlation (R2=0.781). A statistically significant reduction in IH incidence was demonstrated in high-risk groups in which the algorithm was correctly applied (10,2 vs. 46,3%; p=0,0001; OR: 7,58;95%; CI: 3,8-15). Survival analysis showed that the differences remained constant during follow-up. CONCLUSION: The implementation of the algorithm reduces the incidence of IH in high-risk patients. The adherence to the algorithm also correlates with a decrease in the incidence of IH.

Un algoritmo para la colocación de malla profiláctica en pacientes de riesgo reduce la incidencia de hernia incisional tras laparotomía por cáncer colorrectal / The use of an algorithm for prophylactic mesh use in high risk patients reduces the incidence of incisional hernia following laparotomy for colorectal cancer resection

INTRODUCCIÓN: Existe una alta incidencia de hernia incisional (HI) tras cirugía de colon. El objetivo de este estudio fue analizar la utilidad de un algoritmo de decisión para la colocación de malla profiláctica tras laparotomía media por cáncer colorrectal en pacientes de riesgo. MÉTODOS: Se planteó un estudio prospectivo que incluyera a los pacientes intervenidos de cáncer colorrectal por laparotomía media entre enero de 2011 y junio de 2014, tras la implementación de un algoritmo de decisión para la colocación de malla profiláctica en pacientes seleccionados de alto riesgo. Se realizó análisis por intención de tratar entre los pacientes en los que se siguió correctamente el algoritmo y en los que no. RESULTADOS: De los 235 pacientes analizados, el algoritmo se siguió correctamente en 166 pacientes, los 69 restantes se usaron como grupo control. Partiendo de una adherencia inicial del 40% en el primer semestre del estudio, se logró llegar a un cumplimiento del 90,3% en el último semestre. La incidencia de HI disminuyó progresivamente a medida que aumentaba la adherencia (de 28 a 0%), con una correlación tiempo-dependiente (R2=0,781). Se logró una disminución estadísticamente significativa de HI en los grupos en los que el algoritmo se aplicó correctamente (10,2 vs. 46,3%; p = 0,0001; OR 7,58;95% IC: 3,8-15). El análisis de supervivencia demostró que las diferencias se mantuvieron constantes durante el seguimiento. CONCLUSIONES: La implementación del algoritmo redujo la incidencia de HI en pacientes de riesgo. La adherencia al algoritmo se correlaciona con el descenso en la incidencia de HI

OBJECTIVE: Incisional hernia (IH) after colorectal surgery is highly prevalent. The objective of this study is to assess the utility of an algorithm to decide on mesh augmentation after a midline laparotomy for colorectal resection to prevent IH in high-risk patients. METHODS: A prospective study was conducted including all patients undergoing a midline laparotomy for colorectal resection between January 2011 and June 2014, after the implementation of a decision algorithm for prophylactic mesh augmentation in selected high-risk patients. Intention-to-treat analyses were conducted between patients in which the algorithm was correctly applied and those in which it was not. RESULTS: From the 235 patients analysed, the algorithm was followed in 166 patients, the resting 69 cases were used as a control group. From an initial adherence to the algorithm of 40% in the first semester, a 90.3% adherence was achieved in the seventh semester. The incidence of IH decreased as the adherence to the algorithm increased (from 28 to 0%) with a time-related correlation (R2=0.781). A statistically significant reduction in IH incidence was demonstrated in high-risk groups in which the algorithm was correctly applied (10,2 vs. 46,3%; p = 0,0001; OR: 7,58;95%; CI: 3,8-15). Survival analysis showed that the differences remained constant during follow-up. CONCLUSION: The implementation of the algorithm reduces the incidence of IH in high-risk patients. The adherence to the algorithm also correlates with a decrease in the incidence of IH