Abstract
BackgroundAbdominal aortic aneurysms (AAA) have most probably an inflammatory origin, whereby the elastica is the layer actually involved. In the past, collagen weackness was supposed to be the shared cause of both, AAA and incisional hernias. Since the development of new techniques of closure of the abdominal wall over the last decade, collagen deficency seems to play only a secondary etiologic role.ObjectivesThe aim of the study was to investigate whether the incidence of incisional hernia following laparotomy due to AAA differs from that of colorectal interventions.Material and methodsThis was a retrospective control matched cohort study. After screening of 403 patients with colorectal interventions and 96 patients with AAA, 27 and 72 patients, respectively were included. The match criteria for inclusion of patients with colorectal interventions were: age, benign underlying disease and median xiphopubic laparotomy. The primary endpoint was the incidence of an incisional hernia. The secondary endpoints were the risk profile, length of stay in the intensive care unit and postoperative complications. Data analysis was carried in the consecutive collective from 2006 to 2008.ResultsIn the group with AAA the mean follow-up was 34.5±18.1 months and in the group with colorectal interventions 35.7±21.4 months. The incidence of incisional hernias showed no significant differences between the two groups. In the AAA group 10 patients (13.8%) developed an incisional hernia in contrast to 7 patients in the colorectal intervention group (25.9%).ConclusionsIn our collective patients with AAA did not show an increased incidence of incisional hernia in comparison to patients with colorectal interventions with comparable size of the laparotomy access and age. The quality of closure of the abdominal wall seems to be an important factor for the prevention of incisional hernia.
Highlights
The development of incisional hernia following abdominal surgeryis anundesired and, depending on the findings, high-risk event
It was long suspected that aortic aneurysms were caused by a collagen defect [6] and that these patients were at high risk for developing incisional hernia; according to the current state of knowledge on the development of aortic aneurysms, collagen metabolism is no longer considered to be a major triggering factor
Due to the differing surgical indications, the patient cohort comprising 499 cases was divided into two groups for comparison, with 96 cases belonging to the aortic aneurysm group and 403 cases to the colorectal procedure group
Summary
The development of incisional hernia following abdominal surgeryis anundesired and, depending on the findings, high-risk event. There are a number of theories on the etiology of incisional hernia, with the techniques of abdominal closure and collagen metabolism being the two most important. The aim of the study was to investigate whether the incidence of incisional hernia following laparotomy due to AAA differs from that of colorectal interventions. In the AAA group 10 patients (13.8%) developed an incisional hernia in contrast to 7 patients in the colorectal intervention group (25.9%). In our collective patients with AAA did not show an increased incidence of incisional hernia in comparison to patients with colorectal interventions with comparable size of the laparotomy access and age. The quality of closure of the abdominal wall seems to be an important factor for the prevention of incisional hernia
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