Elective Incisional Hernia Repair: Risk Factors and Evolution of Treatment in a Low-Income Setting.

Abstract

The steady rise in laparotomy rates, particularly resulting from gynecologic and obstetric procedures in our environment has given rise to corresponding increase in the proportions of incisional hernias (IH). Over the years, discussion on the appropriate repair technique for IH has continued, nevertheless, with advances in laparo-endoscopy and introduction of prosthetic meshes, the surgical treatment has been revolutionized. The aim of this study is to examine the risk factors and the evolutionary trend in surgical repair in our center. This is a descriptive prospective study of adult patients with incisional hernias. The study was carried out in a tertiary health institution from January 2011 to December 2017. A total of 177 patients were recruited, 147 (83.1%) females and 30 (16.9%) males. Nearly two-thirds, 115 patients (65.0%) received prosthetic mesh repair, the rest, 62 patients (35.0%) were fixed using suture-based techniques. Among the 115 mesh repairs, 110 (995.7%) were in females and the remaining five (4.3%) were in males. The most frequent precipitating surgery was caesarean section in 72 patients (40.7%), followed by gynecology operations, 45 patients (25.4%), none-obstetrics and gynecology laparotomies, 50 patients (28.2%) and others, 10 patients (5.7%). Of the 177 patients evaluated, in 99 patients (55.9%) there was history of wound infection in the previous surgery while 24.9%, 5.1%, 4.5% and 1.1% reported that they had prolonged cough, diabetes, jaundice, and urinary obstruction in the peri-operative period of the initiating operations. The rate of recurrence was 17.7% in the non-mesh repairs and 0.0% in the group that had mesh repair. In our locality, the trend over time shows a shift from predominantly anatomic suture-based repair to a tensionless mesh implant with far lower recurrent rates. Laparotomy incisions for obstetric and gynecologic procedures are the most common precipitating incisions.