Skip to main content
SpringerLink
Log in

Preoperative Preparation of the Patient Undergoing Incisional Hernia Repair: Optimizing Chances for Success

  • Chapter
  • First Online:
Hernia Surgery

  • 4964 Accesses

Abstract

Recurrence rates following successful incisional hernia repair are reported to be between 10 and 60 %. Although most recurrences occur within 2 years of repair, they can recur for up to 30 years, with repairs of recurrent hernias having an even higher recurrence rate. Although some causes of hernia recurrences are related to surgical technique, several patient factors contribute profoundly to hernia recurrence by delaying wound healing, or actually causing necrosis or absorption of connective tissue. Modifiable factors, such as smoking, obesity, and hyperglycemia should be addressed and corrected before elective repair, if possible. By eliminating or reducing these factors, one optimizes a patient’s chance of undergoing successful hernia repair without recurrence, post-op infectious complications, or delayed wound healing.

Because the success of hernia repair is often measured by the absence of recurrence, the focus of preoperative optimization aims at eliminating factors that inhibit wound healing. The focus of preoperative optimization on these entities and their correction, if they are abnormal, will give the patient the best chance for successful repair.

In addition, interventions performed in the immediate perioperative period, like the appropriate choosing and timing of prophylactic antibiotics, metabolic preparation with specific nutrients and/or carbohydrate-loading, choice of alcohol-containing skin preps, and preoperative decolonization of MRSA and MSSA from the nostrils and skin, are important interventions, which, when implemented, will minimize perioperative morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg. 2003;237(1):129–35.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M, et al. Criteria for definition of a complex abdominal wall hernia. Hernia. 2014;18(1):7–17.

    Article  CAS  PubMed  Google Scholar 

  3. Martindale RG, Deveney CW. Preoperative risk reduction: strategies to optimize outcomes. Surg Clin North Am. 2013;93(5):1041–55.

    Article  PubMed  Google Scholar 

  4. Khullar D, Maa J. The impact of smoking on surgical outcomes. J Am Coll Surg. 2012;215(3):418–26.

    Article  PubMed  Google Scholar 

  5. Mastracci TM, Carli F, Finley RJ, Muccio S, Warner DO. Members of the evidence-based reviews in surgery G. Effect of preoperative smoking cessation interventions on postoperative complications. J Am Coll Surg. 2011;212(6):1094–6.

    Article  PubMed  Google Scholar 

  6. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144–54.

    Article  PubMed  Google Scholar 

  7. Sorensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012;255(6):1069–79.

    Article  PubMed  Google Scholar 

  8. Kuri M, Nakagawa M, Tanaka H, Hasuo S, Kishi Y. Determination of the duration of preoperative smoking cessation to improve wound healing after head and neck surgery. Anesthesiology. 2005;102(5):892–6.

    Article  PubMed  Google Scholar 

  9. Sorensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Archiv Surg. 2012;147(4):373–83.

    Article  Google Scholar 

  10. Sorensen LT, Toft BG, Rygaard J, Ladelund S, Paddon M, James T, et al. Effect of smoking, smoking cessation, and nicotine patch on wound dimension, vitamin C, and systemic markers of collagen metabolism. Surgery. 2010;148(5):982–90.

    Article  PubMed  Google Scholar 

  11. Praveen Raj P, Senthilnathan P, Kumaravel R, Rajpandian S, Rajan PS, Anand Vijay N, et al. Concomitant laparoscopic ventral hernia mesh repair and bariatric surgery: a retrospective study from a tertiary care center. Obesity Surg. 2012;22(5):685–9.

    Article  CAS  Google Scholar 

  12. Eid GM, Wikiel KJ, Entabi F, Saleem M. Ventral hernias in morbidly obese patients: a suggested algorithm for operative repair. Obesity Surg. 2013;23(5):703–9.

    Article  Google Scholar 

  13. Dronge AS, Perkal MF, Kancir S, Concato J, Aslan M, Rosenthal RA. Long-term glycemic control and postoperative infectious complications. Archiv Surg. 2006;141(4):375–80.

    Article  Google Scholar 

  14. Berbari EF, Osmon DR, Lahr B, Eckel-Passow JE, Tsaras G, Hanssen AD, et al. The Mayo prosthetic joint infection risk score: implication for surgical site infection reporting and risk stratification. Infect Control Hosp Epidemiol. 2012;33(8):774–81.

    Article  PubMed  Google Scholar 

  15. Ramos M, Khalpey Z, Lipsitz S, Steinberg J, Panizales MT, Zinner M, et al. Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg. 2008;248(4):585–91.

    PubMed  Google Scholar 

  16. Martindale RG, McClave SA, Taylor B, Lawson CM. Perioperative nutrition: what is the current landscape? J Parenter Enteral Nutr. 2013;37(5 Suppl):5S–20S.

    Article  Google Scholar 

  17. Daley J, Khuri SF, Henderson W, Hur K, Gibbs JO, Barbour G, et al. Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg. 1997;185(4):328–40.

    CAS  PubMed  Google Scholar 

  18. Munroe C, Frantz D, Martindale RG, McClave SA. The optimal lipid formulation in enteral feeding in critical illness: clinical update and review of the literature. Curr Gastroenterol Rep. 2011;13(4):368–75.

    Article  PubMed  Google Scholar 

  19. Jie B, Jiang ZM, Nolan MT, Zhu SN, Yu K, Kondrup J. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition. 2012;28(10):1022–7.

    Article  PubMed  Google Scholar 

  20. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc EWG. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–36.

    Article  PubMed  Google Scholar 

  21. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gianotti L, Braga M, Nespoli L, Radaelli G, Beneduce A, Di Carlo V. A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. Gastroenterology. 2002;122(7):1763–70.

    Article  CAS  PubMed  Google Scholar 

  23. Braga M, Gianotti L, Vignali A, Schmid A, Nespoli L, Di Carlo V. Hospital resources consumed for surgical morbidity: effects of preoperative arginine and omega-3 fatty acid supplementation on costs. Nutrition. 2005;21(11–12):1078–86.

    Article  CAS  PubMed  Google Scholar 

  24. Braga M, Gianotti L, Nespoli L, Radaelli G, Di Carlo V. Nutritional approach in malnourished surgical patients: a prospective randomized study. Archiv Surg. 2002;137(2):174–80.

    Article  Google Scholar 

  25. Manchio JV, Litchfield CR, Sati S, Bryan DJ, Weinzweig J, Vernadakis AJ. Duration of smoking cessation and its impact on skin flap survival. Plast Reconstr Surg. 2009;124(4):1105–17.

    Article  CAS  PubMed  Google Scholar 

  26. Braga M. Perioperative immunonutrition and gut function. Curr Opin Clin Nutr Metab Care. 2012;15(5):485–8.

    Article  CAS  PubMed  Google Scholar 

  27. Drover JW, Dhaliwal R, Weitzel L, Wischmeyer PE, Ochoa JB, Heyland DK. Perioperative use of arginine-supplemented diets: a systematic review of the evidence. J Am Coll Surg. 2011;212(3):385–99.

    Article  PubMed  Google Scholar 

  28. Serhan CN. Pro-resolving lipid mediators are leads for resolution physiology. Nature. 2014;510(7503):92–101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Pluess TT, Hayoz D, Berger MM, Tappy L, Revelly JP, Michaeli B, et al. Intravenous fish oil blunts the physiological response to endotoxin in healthy subjects. Intensive Care Med. 2007;33(5):789–97.

    Article  CAS  PubMed  Google Scholar 

  30. Calder PC. Fatty acids and inflammation: the cutting edge between food and pharma. Eur J Pharmacol. 2011;668 Suppl 1:S50–8.

    Article  CAS  PubMed  Google Scholar 

  31. Marik PE, Flemmer M. The immune response to surgery and trauma: implications for treatment. J Trauma Acute Care Surg. 2012;73(4):801–8.

    Article  CAS  PubMed  Google Scholar 

  32. Rudolph FB, Van Buren CT. The metabolic effects of enterally administered ribonucleic acids. Curr Opin Clin Nutr Metab Care. 1998;1(6):527–30.

    Article  CAS  PubMed  Google Scholar 

  33. Burden S, Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev. 2012;11:CD008879.

    Google Scholar 

  34. Svanfeldt M, Thorell A, Hausel J, Soop M, Nygren J, Ljungqvist O. Effect of “preoperative” oral carbohydrate treatment on insulin action—a randomised cross-over unblinded study in healthy subjects. Clin Nutr. 2005;24(5):815–21.

    Article  CAS  PubMed  Google Scholar 

  35. Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am J Physiol Endocrinol Metab. 2001;280(4):E576–83.

    CAS  PubMed  Google Scholar 

  36. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466–77.

    Article  CAS  PubMed  Google Scholar 

  37. Awad S, Constantin-Teodosiu D, Constantin D, Rowlands BJ, Fearon KC, Macdonald IA, et al. Cellular mechanisms underlying the protective effects of preoperative feeding: a randomized study investigating muscle and liver glycogen content, mitochondrial function, gene and protein expression. Ann Surg. 2010;252(2):247–53.

    Article  PubMed  Google Scholar 

  38. Awad S, Fearon KC, Macdonald IA, Lobo DN. A randomized cross-over study of the metabolic and hormonal responses following two preoperative conditioning drinks. Nutrition. 2011;27(9):938–42.

    Article  CAS  PubMed  Google Scholar 

  39. Maung AA, Davis KA. Perioperative nutritional support: immunonutrition, probiotics, and anabolic steroids. Surg Clin North Am. 2012;92(2):273–83.

    Article  PubMed  Google Scholar 

  40. Baucom RB, Beck WC, Holzman MD, Sharp KW, Nealon WH, Poulose BK. Prospective evaluation of surgeon physical examination for detection of incisional hernias. J Am Coll Surg. 2014;218(3):363–6.

    Article  PubMed  Google Scholar 

  41. Franklin BR, Patel KM, Nahabedian MY, Baldassari LE, Cohen EI, Bhanot P. Predicting abdominal closure after component separation for complex ventral hernias: maximizing the use of preoperative computed tomography. Ann Plast Surg. 2013;71(3):261–5.

    Article  CAS  PubMed  Google Scholar 

  42. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect. 2013;14(1):73–156.

    Article  Google Scholar 

  43. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8.

    Article  CAS  PubMed  Google Scholar 

  44. Cassar K, Munro A. Surgical treatment of incisional hernia. Br J Surg. 2002;89(5):534–45.

    Article  CAS  PubMed  Google Scholar 

  45. Swenson BR, Hedrick TL, Metzger R, Bonatti H, Pruett TL, Sawyer RG. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infect Control Hosp Epidemiol. 2009;30(10):964–71.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Darouiche RO, Wall Jr MJ, Itani KM, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010;362(1):18–26.

    Article  CAS  PubMed  Google Scholar 

  47. Swenson BR, Sawyer RG. Importance of alcohol in skin preparation protocols. Infect Control Hosp Epidemiol. 2010;31(9):977.

    Article  PubMed  Google Scholar 

  48. Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011(11):CD004122.

    Google Scholar 

  49. Jakobsson J, Perlkvist A, Wann-Hansson C. Searching for evidence regarding using preoperative disinfection showers to prevent surgical site infections: a systematic review. Worldviews Evid Based Nurs. 2011;8(3):143–52.

    Article  PubMed  Google Scholar 

  50. Dumville JC, McFarlane E, Edwards P, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev. 2013;3:CD003949.

    Google Scholar 

  51. Manunga Jr J, Olak J, Rivera C, Martin M. Prevalence of methicillin-resistant Staphylococcus aureus in elective surgical patients at a public teaching hospital: an analysis of 1039 patients. Am Surg. 2012;78(10):1096–9.

    PubMed  Google Scholar 

  52. Savage JW, Anderson PA. An update on modifiable factors to reduce the risk of surgical site infections. Spine J. 2013;13(9):1017–29.

    Article  PubMed  Google Scholar 

  53. Edmiston Jr CE, Okoli O, Graham MB, Sinski S, Seabrook GR. Evidence for using chlorhexidine gluconate preoperative cleansing to reduce the risk of surgical site infection. AORN J. 2010;92(5):509–18.

    Article  PubMed  Google Scholar 

  54. Chlebicki MP, Safdar N, O’Horo JC, Maki DG. Preoperative chlorhexidine shower or bath for prevention of surgical site infection: a meta-analysis. Am J Infect Control. 2013;41(2):167–73.

    Article  CAS  PubMed  Google Scholar 

  55. Bode LG, Kluytmans JA, Wertheim HF, Bogaers D, Vandenbroucke-Grauls CM, Roosendaal R, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med. 2010;362(1):9–17.

    Article  CAS  PubMed  Google Scholar 

  56. Kim DH, Spencer M, Davidson SM, Li L, Shaw JD, Gulczynski D, et al. Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery. J Bone Joint Surg Am. 2010;92(9):1820–6.

    Article  PubMed  Google Scholar 

  57. Huang SS, Septimus E, Kleinman K, Moody J, Hickok J, Avery TR, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368(24):2255–65.

    Article  CAS  PubMed  Google Scholar 

  58. Justinger C, Moussavian MR, Schlueter C, Kopp B, Kollmar O, Schilling MK. Antibacterial [corrected] coating of abdominal closure sutures and wound infection. Surgery. 2009;145(3):330–4.

    Article  PubMed  Google Scholar 

  59. Justinger C, Slotta JE, Ningel S, Graber S, Kollmar O, Schilling MK. Surgical-site infection after abdominal wall closure with triclosan-impregnated polydioxanone sutures: results of a randomized clinical pathway facilitated trial (NCT00998907). Surgery. 2013;154(3):589–95.

    Article  PubMed  Google Scholar 

  60. Chang WK, Srinivasa S, Morton R, Hill AG. Triclosan-impregnated sutures to decrease surgical site infections: systematic review and meta-analysis of randomized trials. Ann Surg. 2012;255(5):854–9.

    Article  PubMed  Google Scholar 

  61. Reid K, Pockney P, Draganic B, Smith SR. Barrier wound protection decreases surgical site infection in open elective colorectal surgery: a randomized clinical trial. Dis Colon Rectum. 2010;53(10):1374–80.

    Article  PubMed  Google Scholar 

  62. Horiuchi T, Tanishima H, Tamagawa K, Matsuura I, Nakai H, Shouno Y, et al. Randomized, controlled investigation of the anti-infective properties of the Alexis retractor/protector of incision sites. J Trauma. 2007;62(1):212–5.

    Article  PubMed  Google Scholar 

  63. Flores-Maldonado A, Medina-Escobedo CE, Rios-Rodriguez HM, Fernandez-Dominguez R. Mild perioperative hypothermia and the risk of wound infection. Arch Med Res. 2001;32(3):227–31.

    Article  CAS  PubMed  Google Scholar 

  64. Qadan M, Gardner SA, Vitale DS, Lominadze D, Joshua IG, Polk Jr HC. Hypothermia and surgery: immunologic mechanisms for current practice. Ann Surg. 2009;250(1):134–40.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli G, Fortelny R, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])-Part III. Surg Endosc. 2014;28(2):380–404.

    Article  CAS  PubMed  Google Scholar 

  66. Fakhry SM, Montgomery SC. Peri-operative oxygen and the risk of surgical infection. Surg Infect. 2012;13(4):228–33.

    Article  Google Scholar 

  67. Greif R, Akca O, Horn EP, Kurz A, Sessler DI, Outcomes Research G. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med. 2000;342(3):161–7.

    Article  CAS  PubMed  Google Scholar 

  68. Belda FJ, Aguilera L, Garcia de la Asuncion J, Alberti J, Vicente R, Ferrandiz L, et al. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA. 2005;294(16):2035–42.

    Article  CAS  PubMed  Google Scholar 

  69. Meyhoff CS, Wetterslev J, Jorgensen LN, Henneberg SW, Hogdall C, Lundvall L, et al. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA. 2009;302(14):1543–50.

    Article  CAS  PubMed  Google Scholar 

  70. Al-Niaimi A, Safdar N. Supplemental perioperative oxygen for reducing surgical site infection: a meta-analysis. J Eval Clin Pract. 2009;15(2):360–5.

    Article  PubMed  Google Scholar 

  71. McFarland LV. Antibiotic-associated diarrhea: epidemiology, trends and treatment. Future Microbiol. 2008;3(5):563–78.

    Article  PubMed  Google Scholar 

  72. Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JN, Shanman R, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012;307(18):1959–69.

    Article  CAS  PubMed  Google Scholar 

  73. Johnston BC, Ma SS, Goldenberg JZ, Thorlund K, Vandvik PO, Loeb M, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med. 2012;157(12):878–88.

    Article  PubMed  Google Scholar 

  74. Goldenberg JZ, Ma SS, Saxton JD, Martzen MR, Vandvik PO, Thorlund K et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2013;5:CD006095.

    Google Scholar 

  75. Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil. 2011;25(2):99–111.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L223A, Portland, OR, 97239, USA

    Robert G. Martindale & Clifford W. Deveney

Authors
  1. Robert G. Martindale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clifford W. Deveney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert G. Martindale .

Editor information

Editors and Affiliations

  1. Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, Ohio, USA

    Yuri W. Novitsky

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Martindale, R.G., Deveney, C.W. (2016). Preoperative Preparation of the Patient Undergoing Incisional Hernia Repair: Optimizing Chances for Success. In: Novitsky, Y. (eds) Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27470-6_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27470-6_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27468-3

  • Online ISBN: 978-3-319-27470-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation