Prevention of Incisional Hernia in High Risk Patients

Overview

Featured Article


Jairam AP at el. Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet 2017;390(10094):567-76

Expert Reviews


Methodological Reviewer: Bas Wijnhoven MD, PhD,  Department of Surgery, University Medical Center Rotterdam

Clinical Reviewer: Jacinthe Lampron MD, MPH, FRCSC, FACS, Department of Surgery, University of Ottawa

Clinical Reviewer: David Spain MD, FACS, Department of Surgery, Stanford University

Supplementary Articles


Urschel JD, Goldsmith CH, Tandan VR, et al; for the Evidence-Based Surgery Working Group. Users’ guide to evidence-based surgery: how to use an article evaluating surgical interventions. Can J Surg 2001;44(2):95-100

Questions


Please read the above articles and be prepared to discuss the following:

  1. 1. What is the clinical question being addressed?
    2. Was the assignment of patients to treatment randomized and concealed?
    3. Were all patients who entered the trial properly accounted for and attributed for at its conclusion?
    4. Were patients, their clinicians and study personnel “blind” to treatment?
    5. Were the groups similar at the start of the trial?
    6. Aside from the experimental intervention, were the groups treated equally?
    7. How large and precise was the treatment effect?
    8. Were the study patients similar to my patients?
    9. Were the measured outcomes clinically relevant?
    10. Were all clinically important outcomes considered?
    11. Are my surgical skills similar to those of the study surgeons?
    12. State the conclusion. Have the authors addressed the clinical question posed?
    13. Does the evidence support the conclusion?