Dados do Resumo

Título

Predictors and Prevention of Incisional Hernia Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Introdução

An incisional hernia (IH) is an opening in the abdominal wall with or without a protrusion in the postoperative scar area, resulting from factors that weaken the abdominal wall, such as increased abdominal pressure and inadequate healing. IH is a common complication in up to 20% of cases of patients undergoing midline laparotomy, as in cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), and can cause pain, obstruction, incarceration, and strangulation.

Objetivo

To analyze the risk factors for the development of incisional hernia in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy and to evaluate the effectiveness of preventive measures used in high-risk patients to reduce the incidence of this complication.

Métodos

This is a scientific literature review in which studies were selected from the PubMed, Scielo, and Elsevier databases, using the descriptors “incisional hernia” and “cytoreductive surgery,” connected by the Boolean operator “AND.” The publication period considered was between 2014 and 2024. For the review selection, systematic reviews, randomized clinical trials, meta-analyses, and literature reviews were included, with a focus on statistically significant studies with p<0.05. Additionally, articles addressing risk factors and preventive measures associated with the increase and reduction of incisional hernia were also included.

Resultados

The studies analyzed do not present a complete consensus on the risk and protective factors related to the development of incisional hernia (IH). However, each study, through univariate and multivariate analyses, highlighted factors that increased the incidence of incisional hernia in cytoreduction with HIPEC, such as patients with pseudomyxoma peritonei and peritoneal mesothelioma, female sex, advanced age, BMI greater than 30, poor nutritional status, cardiovascular disease, the need for intestinal anastomosis during the procedure, early postoperative surgical complications, and preoperative chemotherapy. Regarding preventive measures, a reduction in IH was observed when laparotomy was combined with the placement of a prophylactic mesh compared to traditional closure. Additionally, increasing the suture-to-wound length ratio was also a protective factor.

Conclusões

It is inferred, therefore, that incisional hernia is a common complication in laparotomies, such as in CRS with HIPEC. Thus, identifying high-risk patients is essential to implementing effective preventive measures during the surgical procedure.

Palavras Chave

incisional hernia; cytoreductive surgery