COMPARATIVE STUDY OF PRIMARY REPAIR WITH OPEN MESHPLASTY V/S ABDOMINOPLASTY IN A TERTIARY CARE HOSPITAL IN ASSESSING THE OUTCOME OF INCISIONAL HERNIA

Abstract

Incisional hernias are hernias which occur as a result of excessive tension and inadequate healing of a previous incision1. Incidence of these hernias is 9.9% worldwide. These hernias arise through a defect in the musculo-fascial layers of the abdominal wall in the region of a postoperative scar. They can enlarge over time, leading to pain, obstruction, incarceration and strangulation. With loss of domain, the natural rigidity of the abdominal wall becomes compromised and the abdominal musculature is often retracted. Treatment includes Meshplasty or Abdominoplasty. In meshplasty surgery, the abdominal contents are reduced and the defect is closed. Following this, an onlay or inlay mesh is placed which secures the primary repair as well as allows brosis of the anterior abdominal wall by capillary and broblasts neovascularization in the spaces between the mesh. The advantage of using a mesh is for closing large defects or for defects in which abdomen cannot be closed by primary intention. Infection of the mesh, seroma, abscess formation, recurrence, surgical site infection, changes or loss in the abdominal domain are a few complications associated with this surgery. Another method of repair of these incisional hernias in our study is by abdominoplasty. In Abdominoplasty, we will plicate the linea alba from xiphisternum to pubic symphysis after closure of defect. The biggest drawback of meshplasty which is infection, is prevented in abdominoplasty. Additionally, abdominoplasty can provide an added advantage of it being cost effective. Here in this study, we will to compare and evaluate Primary Repair with Open Meshplasty v/s Abdominoplasty in cases of incisional hernias, on the their surgical outcome on the basis of rate of infection, ap necrosis, rate of recurrence and post-operative cosmesis.