Incisional hernia following aortic surgery

Abstract

Controversy exists in the literature regarding the incidence of incisional hernia formation after aortic reconstruction and the rate of incisional hernia formation in vertical midline and transverse incisions. We reviewed the incidence of incisional hernia after aneurysm (AAA) or occlusive disease (OCC) aortic operations and the incidence of incisional herniorrhaphy for vertical midline versus transverse incisions. Through a retrospective chart review of patients between 1970 and 1998, 618 patients who underwent incisional herniorrhaphy, 265 who underwent AAA repairs, and 331 who underwent OCC repairs were identified. These three groups were cross-referenced to identify patients who underwent incisional herniorrhaphy following aortic reconstruction. Patients were analyzed and compared according to presence of AAA or OCC and the incision and suture material used during the aortic repair. Thirty-six patients underwent incisional herniorrhaphy following aortic reconstruction. Twenty-six patients (9.8%) required incisional herniorrhaphy after AAA repair (22 vertical midline incisions, 4 transverse incisions). All ten patients (3%) who underwent incisional herniorrhaphy after OCC repair had vertical midline incisions. The difference in the incidence of incisional hernia repair (9.8% vs 3.0%) between AAA and OCC was statistically significant (p<0.001). In AAA patients, there was an 11.3% incisional hernia repair rate after vertical midline incisions versus 5.6% after transverse incisions, but the difference was not statistically significant. We have demonstrated a significantly higher incidence of incisional hernia repair following aortic reconstruction for AAA than for OCC repair. Furthermore, we identified a trend towards increased incisional hernia repair after employing vertical midline incisions versus transverse incisions in AAA patients, and a significant risk for incisional hernia after AAA repair when absorbable suture was used.