Discussion
muscle atrophy, hernia, pain, seroma, Seroma
MUSCLE ATROPHY, WOUND INFECTION, RECRUITMENT, SEROMA, SEROMA
To our knowledge, the present ABIHR-II project is the first study to investigate the effects of AB on SSI rate, seroma formation, limited mobility, general well-being, and pain at rest after open IHR with the sublay technique. AB is frequently prescribed and the open sublay procedure is frequently performed. Therefore, the analysis of these endpoints seems to be important to further optimize the postoperative course [The SSI rate after IHR with the sublay technique is about 15–20% [Seroma formation is common after open IHR. According to an analysis of the Herniamed registry, the seroma formation rate in 3965 patients who underwent sublay IHR is approximately 5% [It is conceivable that AB helps to prevent seroma formation, as it can reduce the size of the hernia sac and the future seroma space [It can be postulated that AB may limit mobility after surgery. Even muscle atrophy due to lack of abdominal muscle use from wearing an AB has been discussed [Both groups did not differ significantly in terms of pain at rest (AB group, 17.1; No-AB group, 16.6; Table Our results suggest that wearing an AB after IHR may affect the SSI rate. Further studies are mandatory to confirm these findings because if the AB does not have to be prescribed it could lead to a reduction in costs. In 2019, a total of 48,793 people underwent surgery for incisional hernia [As study limitations, the ABIHR-II studies, which began in 2019, faced recruitment challenges due to the COVID-19 pandemic. An amendment was requested in 2021 to reduce the pilot study's sample size from 60 to 50 patients due to the pandemic's impact on elective surgical programs in major hospitals in Germany. Due to an organizational error, one more patient than planned was enrolled in the study after the sample size was reduced (Unfortunately, the SSI was not further differentiated due to a lack of a 30-day follow-up and the instruction to do so (the protocol states: wound infection: yes or no). The study relied on subjective measures, such as the VAS for pain at rest and mobility. Objective measures, such as pain medication intake and the six-minute walk test, could improve the study's reliability and generalizability [