Study of laparoscopic repair of abdominal incisional hernia

Abstract

Background: An incisional hernia is defined as any abdominal wall gap with or without bulge in the area of postoperative scar perceptible or palpable by clinical examination or imaging. It occurs in about 3 to 20 percent of patients undergoing laparotomy. Open hernia repair methods have an increased incidence of wound infections and wound-related complications. These problems have been overcome by laparoscopy. The placement of a large mesh by laparoscopy allows for an even distribution of forces along the surface area of the mesh, which account for the strength of the repair and the decreased recurrence rates associated with it. The merits of the laparoscopic approach are decreased rates of recurrence, reduced risks of wound complications. The aims and objective of this study were to evaluate etiological factors of incisional hernia, various techniques of laparoscopic repair of incisional hernia, and to investigate the influence of laparoscopic approach on hospital stay, complications associated with the procedure and recurrence rates.Methods: In this hospital based prospective study, total 40 cases of incisional hernia were studied which were operated laparoscopically and followed up over period of two years.Results: Incisional hernia occurrence was common in females (80%) with commonly observed risk factor was postoperative wound related complications (28 cases) and obesity (22 cases). Infraumbilical midline incision (67.5%) and supraumbilical midline incision (27.5%) was most commonly responsible for incisional hernia occurrence. LSCS was most commonly responsible for incisional hernia occurrence (45%) followed by laparotomy for various indications (27.5%). Intraperitoneal onlay mesh repair of single defect without anatomical repair was most common modality of laparoscopic repair (70%). Early postoperative pain (20%) and prolonged ileus (17.5%) was the most common complication observed. Average hospital stay was 4.22 days.Conclusions: Postoperative wound related complications are important risk factor for incisional hernia. Laparoscopic repair of incisional hernia is better choice in view of reduced wound related complications, post-operative pain and hospitals stay.