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SURVEYS

STANDARD GAMBLE SURGEON SURVEY

Step 1 of 11 - SURGEON INFORMATION

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  • The following three hypothetical scenarios are surgical cases in which prophylactic mesh could be considered to reduce risk of developing an incisional hernia.
  • Laparoscopic Cholecystectomy: Low Risk Scenario
  • ⚬ This patient is a 42-year old woman here for an elective laparoscopic cholecystectomy.
    ⚬ BMI = 24 kg/m2
    ⚬ Past Medical History:
             • Diabetes mellitus
             • Hypertension
    ⚬ Labs:
             • WBC normal
             • LFTs normal
    ⚬ Imaging
             • Ultrasound shows a 3 cm gallstone, GBW 0.3 cm, CBD 0.3 cm.
  • At the moment of gallbladder extraction, incision had to be extended to 3 cm

  • Below is a flow diagram of possible complications with current care.

  • Below is a flow diagram of possible complications with prophylactic mesh.


  • The patient is a 42-year old woman here for an elective laparoscopic cholecystectomy. She has a BMI of 24 kg/m2 and past medical history of diabetes mellitus and hypertension. Her labs show normal WBC count and normal LFTs. Ultrasound shows a 3 cm gallstone with GBW 0.3 cm and CBD 0.3 cm. At the moment of the gallbladder extraction, the incision has to be extended to 3 cm.

  • CURRENT PRACTICE
    Risk of hernia → 5%
    Risk of wound complication → 2%
  • PROPHYLACTIC MESH
    Risk of hernia → 1.6%
    Risk of wound complication → ?
  • Sigmoidectomy: Medium Risk Scenario
  • ⚬ This patient is a 62 year old male smoker who underwent outpatient colonoscopy which revealed sigmoid diverticulosis.
    ⚬ BMI = 42 kg/m2
    ⚬ Past Medical History:
             • Diabetes mellitus
             • Hypertension
             • History of multiple episodes of diverticulitis
  • Hand assisted laparoscopic sigmoid colectomy is planned for this patient

  • Below is a flow diagram of possible complications with current care.


  • Below is a flow diagram of possible complications with prophylactic mesh.


  • This patient is a 62 year old man who underwent outpatient colonoscopy which revealed sigmoid diverticulosis. His BMI is 42 kg/m2 and he is currently a smoker. Past medical history includes diabetes mellitus and hypertension. He also has a history of multiple episodes of diverticulitis. Hand assisted laparoscopic sigmoid colectomy is planned for this patient.

  • CURRENT PRACTICE
    Risk of hernia → 22%
    Risk of wound complication → 10%
  • PROPHYLACTIC MESH
    Risk of hernia → 7%
    Risk of wound complication → ?
  • Exploratory Laparotomy: High Risk Scenario
  • ⚬ TThis patient is a 67 year old male smoker who presents with small bowel obstruction
    ⚬ BMI = 42 kg/m2
    ⚬ Past Medical History:
             • COPD
             • Diabetes mellitus
             • Hypertension
  • Patient subsequently undergoes an exploratory laparotomy with lysis of adhesion with resection of small bowel

  • Below is a flow diagram of possible complications with current care.


  • Below is a flow diagram of possible complications with prophylactic mesh.


  • This patient is a 67 year old man who presents with small bowel obstruction. He has a BMI of 42 kg/m2 and is a current smoker. His past medical history consists of COPD, diabetes mellitus, and hypertension. The patient subsequently underwent an exploratory laparotomy with lysis of adhesions and resection of small bowel.

  • CURRENT PRACTICE
    Risk of hernia → 55%
    Risk of wound complication → 20%
  • PROPHYLACTIC MESH
    Risk of hernia → 18%
    Risk of wound complication → ?

  • A meta-analysis conducted by our lab showed these results on relative risk when using prophylactic mesh:

  • Complications Relative Risk with Prophylactic Mesh
    Hernia 0.32 (68% decreased risk)
    Wound complications (SSI and SSO) 1.65 (65% increased risk)

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