Prevenzione delle ernie incisionali

Le ernie incisionali sono il tipo di complicanza più comune dopo la laparotomia.

3,2 milioni²

Laparotomie in Europa occidentale ogni anno

20 - 80%^3,4,5,6,7,8

Elevato tasso di incidenza delle ernie incisionali

4.731€⁹

Costo medio per riparazione di ernia ventrale incisionale (IVHR)

Costo dell'IVHR in casi gravi: oltre 16.000€⁹

min. 3 miliardi di €

costo annuale medio per il sistema sanitario in Europa occidentale

Cosa dicono le varie linee guida sulla profilassi delle ernie incisionali

Si sviluppa dopo un trauma chirurgico alla parete addominale, con recidive dopo la riparazione delle ernie ventrali primarie.
Può anche essere causata da una deiscenza della parete addominale, completa o incompleta entro 30 giorni dopo l'intervento.
Oppure, durante il posizionamento di una stoma per colostomia, ileostomia o condotto ileale attraverso la parete addominale.

La maggior parte è specifica della procedura
Alcuni sono uno standard in tutte le procedure

I 5 principali fattori di rischio indipendentemente dalla procedura sono:

I fattori biologici ed esterni appena definiti possono essere parametri di selezione per l'identificazione di pazienti ad alto riscio, potenzialmente idonei all'assistenza per la prevenzione delle ernie incisionali.

L'approccio di cura profilattica è basato su due pilastri, come suggerisce la letteratura corrente:

Chiusura della parete addominale

La letteratura^43,44,46 consiglia di eseguire la chiusura della parete addominale con una tecnica di chiusura aponeurotica a singolo strato, utilizzando la Small Bite Technique (rapporto SL/WL 4/1) con una sutura monofilamento a lento assorbimento.

Rinforzo con utilizzo di rete

Le prove cliniche^44,45 dimostrano la sicurezza e l'efficacia dell'utilizzo della rete sintetica profilattica in posizione onlay in seguito alla chiusura della parete addominale per la prevenzione delle ernie incisionali nei pazienti ad alto rischio.

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Sono disponibili ulteriori informazioni su come la tecnologia della rete in poliestere autoancorante ProGrip™ può facilitare il rinforzo delle laparotomie.

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Prevenzione delle ernie incisionali