Incisional Hernia Post Laparotomy-Incidence and Risk Factors

Amjad Shah

doi:10.11648/j.js.20180601.14

Abstract

Laparotomy incisions are one of the most common procedures performed in any surgical service. However, they carry certain risks like surgical site infections, wound dehiscence and incisional hernia. There have been various risk factors associated with the incidence of incisional hernia post laparotomy. Some of these factors are patients- related like history of diabetes, obesity, smoking, sex and age. The other factors are related to the disease process itself like emergency surgeries, presence of peritonitis, history of radiation to the abdominal cavity or presence of surgical site infection. Another set of factors relates purely with the technique used to close the wound, choice of suture material and expertise of the surgeon. Methods. This is a retrospective chart review. Data was collected from all patients who were previously admitted at Hamad General Hospital for laparotomy and subsequently developed incisional hernia. Methods. All patients of age 18 years or above who were found to have incisional hernia after laparotomy were included in the study. Hospital medical records database were used for file reviews. Patients characteristics like age, sex, obesity, history of smoking, DM etc were recorded. Nature of surgeries like emergency or elective were documented along with other factors like suturing techniques etc. Results. The total number of study subjects was 672, out of which 47 (6.9%) developed incisional hernia. Out of these 23 were male and 24 were female. Diabetes was identified in 18 patients (38.3%) whereas the incidence of smoking, steroid use, COPD and obesity was 2 (4.3%), 0 (%), 3 (6.4%) and 7 (14.9%) respectively. Other risk factors like the nature of surgery (emergency vs electives) were addressed also. The incidence of immediate postop complications was also addressed. Three patients out of 47 (6.4%) developed surgical site infection whereas one patient (2.1%) had post -op wound dehiscence. The number of contaminated and dirty wounds during the initial surgery was 10 (21.3%) and 6 (12.8%) respectively.

Highlights

Laparotomy incision has been the standard for abdominal surgeries
There have been various risk factors associated with the incidence of incisional hernia after laparotomy
Diabetes was identified in 18 patients (38.3%) whereas the incidence of smoking, steroid use, COPD and obesity was 2 (4.3%), 0 (%), 3 (6.4%) and 7 (14.9%) respectively

Summary

Introduction

Laparotomy incision has been the standard for abdominal surgeries. It gives better and easy access to the abdominal cavity. Amjad Shah et al.: Incisional Hernia Post Laparotomy-Incidence and Risk Factors hernia incidence have been reported, including gender (both male and female), age, surgical site infection, obesity and aortic aneurysm [1, 4, 11, 6]. Another set of factors relates purely with the technique used to close the wound, choice of suture material and expertise of the surgeon [2, 4, 7, 11]. Other researchers have studied the clinical impact of morbid obesity and steroid use on the incidence of incisional hernia and found to have a protective effect of polypropylene mesh on the incidence of incisional hernia [4, 9, 11]

Data Source and Study Population

Data Analysis

Results

Discussion

Conclusion