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Use of informed algorithm for patients selection of prophylactic mesh aplication after midline laparotomy in emergency surgery.
Midline laparotomy complications have a high rate. When midline laparotomy is performed complications rate is even higher. One of the commons complications is incisional hernia, reaching up to 40%- 50% of cases in High risk groups.
Prophylactic mesh use has been proved to be useful preventing midline laparotomy in elective surgery. Despite this, there is not enough data to recommend its use in emergency surgery.
Aim of the study is to investigate if use of an algorithm of informed decision for use of prophylactic mesh in emergency midline laparotomy reduces incisional hernia incidence.
Prospective cohort study of all consecutive midline laparotomy performed at our emergency surgery department. Compare correct application of algorithm outcomes versus non correct application.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Algorithm use for prphylactic mesh after emergency laparotomy | Experimental | Patients with emergency surgery in whom algorithm for prophylactic mesh is use to help decide abdominal wall mesh reinforcement or not. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Prophylactic mesh implantation | Procedure | Use of an algorithm for prophylactic mesh implantation in high risk patients after emergency midline laparotomy. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Incisional hernia | Diagnosis by clinical or image control of incicionsal hernia during follow up. | Durign first and second year of follow up |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence os surgical site ocurrence complications | Any surgical site ocurrence (SSO) complication will be registered and classified using Clavien-Dindo complication scale. More common complications are:
|
| Measure | Description | Time Frame |
|---|---|---|
| Global rate of complication. | Any postoperative complication will be recorded and classified using Clavien-Dindo scale. | Durign first month of postoperative follow up. |
| Reintervention | A second or subsequent intervention quotations due to postoperative comlications. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Alejandro Bravo-Salva, M.D. | Contact | +34932483204 | abravo@psmar.cat |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital del Mar | Recruiting | Barcelona | Catalonia | 08911 | Spain |
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Patients with emergency surgery using midline laparotomy
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| During first postoperative month. |
| Long term mesh related complications: chronic pain and mesh infection. | Chronic pain: is any pain which persists beyond the normal healing period of 12 weeks. Visual analoge scale will be used to measure it. Mesh infection: Late-onset mesh infection is defined as acute inflammatory response in surgical area within months or years after operation. It is diagnosed by the presence of infection symptoms and imaging examinations. | During first year of follow-up. |
| During first postoperative month follow up. |
| Hospital readmission | Patient admission to a hospital within 30 days after being discharged from an earlier hospital stay | During first postoperative month follow up. |