LAUSR

Presenting our 1-month results in 20 patients with prophylactic negative pressure (pNPWT) applied in complex ventral hernia repairs. pNPWT was applied when high surgical site occurrences (SSO) risk factors and when colorectal procedures, huge panniculectomies, active cutaneous/mesh infections or loss of domain are associated. Our results are compared with SSO incidence calculated with HW-RAT score. 10 men and 10 women with 67.55 (43–84) year-old. BMI 32.01 kg/m2 (24–55). 55% ASA III, 35% II, 10% I. Most relevant risk factors: 3 stoma closures, 3 loss of domain, 2 paraestomal, 2 peritonitis, 2 W3, 2 multi-recurrences, 1 infected mesh, 1 synchronic colonic fistula. HW-RAT SSO score (1-less risk- to 5 -maximum-): 3 II, 3 III, 12 IV and 2 V. pNPWT was applied to 17 midline wounds, 1 bilateral subcostal, 1 colostomy site and 1 midline+colostomy for 6–10 days (mode 7). 12 patients (60%) had 19 complications, 3 grade IIIB and one IVa. Only 1 patient (5%) had surgical site infection (SSI): 1 infected seroma presenting at 16th postoperative day requiring readmission, drainage, and negative pressure (grade IIIA). Global HW-RAT estimated SSI incidence: 15.76%. Two patients had other causes postoperative peritonitis, none of which affected the wound. At 1 month another 2 seromas (1 grade I, 1 grade III) and one 3cm haematoma appeared. pNPWT in high-risk patients is safe and can significantly reduce SSI and SSO (in our series from 15% to 5%). Estimated NNT for preventing 1 SSI in the literature is 9 patients.