Incisional hernia prevention: Prevalence, prediction and prophylaxis

Smith, Laurie 2024. Incisional hernia prevention: Prevalence, prediction and prophylaxis. MD Thesis, Cardiff University. Item availability restricted.

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Abstract

Background and Aims: Incisional hernia is a common consequence of abdominal surgery that affects as many as 1 in 3 patients. The aims of this thesis are to quantify the impact of incisional hernia, identify modifiable risk factors for incisional hernia development and determine barriers to prophylactic mesh use in patients. Materials and Methods: A series of studies were performed, including a cohort study using population level data, a retrospective analysis of randomised control trial data, external validation of a predictive model using an existing dataset. A mixed-methods cohort study was designed and conducted to determine the acceptability of mesh prophylaxis to patients. Results: The incidence of incisional hernia in midline incisions has increased from 12.6% to 16.8%. Patients who develop incisional hernia have higher rates of post-operative complications with higher associated healthcare costs than those that don’t. Grade of surgeon performing abdominal wall closure significantly impacts IH rate (p<0.001). The Penn hernia calculator shows moderate performance in predicting the development of IH in colorectal cancer patients (AUC 0.68). Finally, in spite of negative pre-conceptions of mesh driven by the media, patients would be willing to accept it as a prophylactic treatment option. Acceptability of mesh was dependent on the nature of the information provided and the setting in which it was provided. Discussion: Incisional hernia has a significant impact on patients and healthcare services alike. Focus needs to be on prevention, through implementation of strategies to reduce risk at a local level and changing attitudes towards abdominal wall closure. Identification of the high-risk patient is possible, and surgeons should look at themselves as a barrier to mesh prophylaxis, not the patient.

Item Type:	Thesis (MD)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Medicine
Date of First Compliant Deposit:	13 March 2025
Last Modified:	13 Mar 2025 15:46
URI:	https://orca.cardiff.ac.uk/id/eprint/176855

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