Abstract
BackgroundIncisional herniation is a common complication after abdominal surgery associated with considerable morbidity. The aim of this study was to determine whether incisional hernia is an early complication, in order to understand better the aetiology of incisional hernia formation.MethodsThis study involved the secondary analysis of a subset of patients included in a large RCT comparing small and large tissue bites (5 mm every 5 mm, or 1 cm every 1 cm) in patients scheduled to undergo elective abdominal surgery by midline laparotomy. The distance between the rectus abdominis muscles (RAM distance) was measured by standardized ultrasound imaging 1 month and 1 year after surgery. The relationship between the 1‐year incidence of incisional hernia and the RAM distance at 1 month was investigated.ResultsSome 219 patients were investigated, 113 in the small‐bites and 106 in the large‐bites group. At 1 month after surgery the RAM distance was smaller for small bites than for large bites (mean(s.d.) 1·90(1·18) versus 2·39(1·34) cm respectively; P = 0·005). At 1 year, patients with incisional hernia had a longer RAM distance at 1 month than those with no incisional hernia (mean(s.d.) 2·43(1·48) versus 2·03(1·19) cm respectively; relative risk 1·14, 95 per cent c.i. 1·03 to 1·26, P = 0·015).ConclusionA RAM distance greater than 2 cm at 1 month after midline laparotomy is associated with incisional hernia. Closure with small bites results in a smaller distance between the muscles.
Highlights
Despite many decades of research there is little information about the aetiology of incisional hernia formation
The aim of the present study was to determine whether the RAM distance 1 month after surgery could predict incisional hernia formation, and whether this distance was related to the small-bites technique
This study has confirmed that incisional hernia develops as an early complication after abdominal surgery
Summary
Despite many decades of research there is little information about the aetiology of incisional hernia formation. Two clinical trials[2,3] have suggested that an increased distance between the rectus abdominis muscles (RAM distance) 1 month after surgery predicts later incisional hernia formation. The relationship between the 1-year incidence of incisional hernia and the RAM distance at 1 month was investigated. At 1 month after surgery the RAM distance was smaller for small bites than for large bites (mean(s.d.) 1⋅90(1⋅18) versus 2⋅39(1⋅34) cm respectively; P = 0⋅005). At 1 year, patients with incisional hernia had a longer RAM distance at 1 month than those with no incisional hernia (mean(s.d.) 2⋅43(1⋅48) versus 2⋅03(1⋅19) cm respectively; relative risk 1⋅14, 95 per cent c.i. 1⋅03 to 1⋅26, P = 0⋅015). Funding information Ethicon, Investigator Initiated Clinical Research Funding Grant 09-107 Erasmus University Medical Centre, Efficiency Research Grant 2008-8106
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