Bibliographic Details
| Title: |
Malla profiláctica en laparotomías medias de alto riesgo: revisión crítica y propuesta de algoritmo clínico. |
| Alternate Title: |
Prophylactic Mesh in High-Risk Midline Laparotomies: Critical Review and Proposal of a Clinical Algorithm. |
| Authors: |
Sierra-Duque, Miguel A.1 miguelsierra1998@gmail.com, Arévalo-Guerra, Orlando F.2, Sá-Ribeiro, Flávio A. de3 |
| Source: |
Revista de Cirugia. 2026, Vol. 78 Issue 3, p276-283. 8p. |
| Abstract (English): |
Incisional hernia (IH) is a frequent complication after midline laparotomy, with rates exceeding 40% in high-risk patients. Prophylactic mesh (PM) has emerged as an effective preventive strategy. We conducted a Critical Review and Synthesis of the Evidence published between 2000 and 2025 in PubMed, Scopus, and the Cochrane Library, prioritizing randomized controlled trials (RCTs), meta-analyses, and clinical guidelines. Initial article selection was performed via independent screening by two authors, and evidence regarding clinical outcomes, risk factors, mesh types and positions, and selection criteria was critically analyzed. Evidence indicates that PM significantly reduces IH incidence, particularly after abdominal aortic aneurysm (AAA) repair, with an absolute risk reduction of 27% (from 39,6% to 13,2%) at three years and no increase in infection rates. In patients with BMI ≥ 27 kg/m², the benefit is less consistent. PM is cost-effective, with an incremental cost-effectiveness ratio (ICER) of –42,444 USD per QALY (Quality-Adjusted Life Year), confirming its dominant strategy. A clinical decision algorithm integrating HERNIAscore and Penn Hernia Risk Calculator is proposed to guide individualized application in highrisk populations. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): |
La hernia incisional (HI) es una complicación frecuente tras laparotomía media, con una incidencia superior al 40% en pacientes de alto riesgo. La malla profiláctica (MP) ha surgido como una estrategia preventiva eficaz. Se realizó una Revisión Crítica y Síntesis de la Evidencia publicada entre 2000 y 2025 en PubMed, Scopus y Cochrane Library, priorizando ensayos clínicos aleatorizados (ECA), metaanálisis y guías clínicas. La selección inicial de artículos se realizó mediante cribado independiente por dos autores y se analizó críticamente la evidencia sobre resultados clínicos, factores de riesgo, tipos y posición de malla, así como criterios de indicación. La evidencia demuestra que la MP reduce significativamente la incidencia de HI, especialmente tras reparación de aneurisma de aorta abdominal (AAA), con una reducción absoluta del 27% (de 39,6% a 13,2%) a tres años y sin aumento en la tasa de infección. En pacientes con IMC ≥ 27 kg/m², los beneficios son menos consistentes. La MP es costo-efectiva, con una relación costo-efectividad incremental (ICER) negativo (–42.444 USD/año de vida ajustado por calidad (QALY)), lo que la posiciona como una estrategia dominante. Se propone un algoritmo clínico de decisión basado en modelos predictivos (HERNIAscore y Penn Calculator) para guiar su uso individualizado en poblaciones de alto riesgo. [ABSTRACT FROM AUTHOR] |
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| Database: |
MedicLatina |
