History Of Laparotomy Research Articles

TCTAP C-208 The Success Case of Hybrid Treatment for Type A Acute Aortic Dissection with Multiorgan Ischemia

### Patient initials or identifier number S.M. ### Relevant clinical history and physical exam A 57-year-old man was admitted to our institution complaining of abdominal pain. He had a history of laparotomy for harvesting the right gastroepiploic artery (rGEA) and had previously received coronary

A 16-Year-Old Female with Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome is a rare autosomal dominant disorder of hamartomatous polyposis of the gastrointestinal tract, with pigmentation around lips and macules on the buccal mucosa that typically manifests itself as recurrent colicky abdominal pain and intestinal obstruction due to intussusception. Here we report a case of a 16-year-old girl who presented with abdominal pain, vomiting and previous history of laparotomy for intussusception. Multiple well demarcated black pigmented macules on lips, perioral region, buccal mucosa, digits, palms and soles were noted. She was diagnosed as a case of Peutz-Jeghers syndrome and managed conservatively. DOI: http://dx.doi.org/10.3329/jemc.v4i3.20958 J Enam Med Col 2014; 4(3): 184-187

Safety of percutaneous endoscopic gastrostomy after trauma laparotomy

BackgroundTrauma patients frequently require long-term enteral access because of injuries to the head, neck, or gastrointestinal tract. Noninvasive methods for gastrostomy placement include percutaneous endoscopic gastrostomy (PEG) and percutaneous radiographic gastrostomy (PRG). In patients with recent trauma laparotomy, PEG placement is felt to be relatively contraindicated because of the concerns about altered anatomy. We hypothesize that there is no increased rate of complications related to PEG placement in patients with trauma laparotomy compared with those without laparotomy provided that basic safety principles are followed. Materials and methodsThis retrospective study evaluates all percutaneous gastrostomies (both PEG and PRG) placed in trauma patients admitted at a level I trauma center between January 1, 2007 and March 30, 2010. The electronic medical records of the 354 patients were reviewed through 30 days after procedure, and patients were further subdivided by the history of laparotomy. Statistical analysis was performed using Fisher exact test or two-tailed t-test, as appropriate. ResultsIn patients with no prior trauma laparotomy, successful PEG placement occurred in 92.2% of patients, the remainder underwent PRG placement. Of patients with prior trauma laparotomy, 82.4% had successful PEG placement. Two percent of attempted PEG placements failed in patients with no previous trauma laparotomy, whereas 11.8% failed in patients with recent trauma laparotomy. The overall complication rate was 2.0%, with no recorded complications in patients with trauma laparotomy before PEG placement. ConclusionsThese data suggest that surgeons should not consider recent trauma laparotomy a contraindication to PEG placement.

腹腔鏡下に解除した開腹歴のない大網癒着による絞扼性イレウスの1例

症例は64歳，女性．突然の下腹部痛を主訴に当院外来受診した．開腹手術の既往はなく，来院時身体所見は下腹部正中付近の強い圧痛と筋性防御を認めた．腹部超音波検査で圧痛部位に一致して拡張した小腸を認め，腹部CTで下腹部正中付近でclosed loopを認めた．以上より絞扼性イレウスを強く疑い，発症6時間後に腹腔鏡下イレウス解除術を施行した．腹腔内を観察すると，大網から突出するように暗赤色に変色した長さ約20cmにわたる腸管のループを認め，大網が左側腹部に癒着して形成された索状物により絞扼をきたしていた．索状物を切離し絞扼を解除すると腸管の血流は回復し腸切除は行わずに終刀とした．術後経過は良好で第6病日に退院となった．開腹歴のない大網癒着による絞扼性イレウスは稀であり，さらに腹腔鏡手術によりイレウス解除を行い得た症例は稀である．今回われわれは，希少な症例を経験したので文献的考察を含めて報告する．

Eosinophilic ascites and duodenal obstruction in a patient with liver cirrhosis.

Eosinophilic gastroenteritis (EG) is a rare disease characterized by eosinophilic infiltration of portions of the gastrointestinal tract. Eosinophilic ascites is probably the most unusual and rare presentation of EG and is generally associated with the serosal form of EG. Hereby, we report a case of eosinophilic ascites with duodenal obstruction in a patient with liver cirrhosis. A 50-year-old woman was admitted to our hospital because of abdominal pain, nausea, bloating, and constipation. She had a history of laparotomy because of duodenal obstruction 2 years ago. Based on clinical, radiological, endoscopic, and pathological findings, and given the excluding the other causes of peripheral eosinophilia, the diagnosis of eosinophilic gastroenteritis along with liver cirrhosis and spontaneous bacterial peritonitis was established. Based on the findings of the present case, it is highly recommended that, in the patients presented with liver cirrhosis associated with peripheral blood or ascitic fluid eosinophilia, performing gastrointestinal endoscopy and biopsy can probably reveal this rare disorder of EG.

Iatrogenic Gastrointestinal Injuries During Obstetrical and Gynecological Operation

BackgroundGastrointestinal Injuries (GI) during gynecological operation are uncommon but proper management of these injuries is very important.ObjectivesThe aim of this study was to review the causes and management of gastrointestinal injuries during gynecological and obstetrical operations.Patients and MethodsIn this descriptive retrospective study, 25 patients with gastrointestinal injuries during gynecological and obstetrical operation at Shabihkhani Maternity Hospital in Kashan city were reviewed. Demographic data such as age, gravid, parity, type of surgery or procedure, history of laparotomy, the surgical operation, injury site, time of diagnosis and method of treatment were extracted from medical records.ResultsThe mean age of women was 33.2 ± 7.57 years. Fourty-four percent of the patients had a history of abdominal scar. Thirty-two percent of all GI injuries occurred during total abdominal hysterectomy (TAH). The small bowel was injured in 36% of cases. Fifty-two percent of injuries were diagnosed during the operation and the mean time of injury diagnosis was 2.8 ± 0.9 days.ConclusionsAll of the gynecologic surgeons must be aware of gastrointestinal injuries and should anticipate injury to these organs especially in high-risk patients for decreasing patient morbidity.

Iatrogenic Gastrointestinal Injuries During Obstetrical and Gynecological Operation

Background Gastrointestinal Injuries (GI) during gynecological operation are uncommon but proper management of these injuries is very important. Objectives The aim of this study was to review the causes and management of gastrointestinal injuries during gynecological and obstetrical operations. Patients and Methods In this descriptive retrospective study, 25 patients with gastrointestinal injuries during gynecological and obstetrical operation at Shabihkhani Maternity Hospital in Kashan city were reviewed. Demographic data such as age, gravid, parity, type of surgery or procedure, history of laparotomy, the surgical operation, injury site, time of diagnosis and method of treatment were extracted from medical records. Results The mean age of women was 33.2 ± 7.57 years. 44% of the patients had a history of abdominal scar. 32% of all GI injuries occurred during total abdominal hysterectomy (TAH). The small bowel was injured in 36% of cases. 52% of injuries were diagnosed during the operation and the mean time of injury diagnosis was 2.8 ± 0.9 days. Conclusions All of the gynecologic surgeons must be aware of gastrointestinal injuries and should anticipate injury to these organs especially in high-risk patients for decreasing patient morbidity.

P325 Use of proton pomp inhibitor and upper gastrointestinal symptoms in IBD patients

Background: Recent investigations suggested the association between use of proton pomp inhibitor (PPI), and Clostridium difficile infection and fracture/osteoporosis, which inflammatory bowel disease (IBD) patients are at risk for both. Methods: We investigated the frequency of PPI use and upper gastrointestinal (GI) symptoms, i.e., gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) in IBD outpatients. Participants were invited and agreed to participate in this study at their regular follow-up visit in our institution between June and September 2011. Patients with symptomatic upper GI Crohn’s disease were excluded. A self-administered questionnaire was given to evaluate age, sex, body mass index, smoking history, IBD diagnosis, age at IBD onset, surgical history, current and past IBD medications, use of antipsychotics, NSAIDs, histamine 2 antagonist and PPI. Concomitant GERD and FD were diagnosed by the questionnaire according to Montreal definition and Rome 3 criteria, respectively. Results: Total 272 (164 male and 108 female) patients were evaluated. 193 UC and 78 CD patients were included. Average age was 41.1±15.1 (S.D.) yrs. Disease duration was 6.0 yrs (median). 33 patients (12.2%) had a history of laparotomy. 21 (7.8%) and 67 (24.9%) patients were current and past smokers, respectively. Medications being used were 5-ASA in 184 (67.6%) , corticosteroid (CS) in 9 (3.3%) , immunomodulator in 109 (40.1%) , tacrolimus in 12 (4.4%) , and biologics in 57 (21.0%) patients. GERD and FD were complicated in 28 (10.3%) and 75 (27.6%) patients each. PPI users (n = 26) and non-users (n = 246) were compared. Compared with non-users, users were older (49.1 vs 40.2 yrs, p = 0.004), used more often CS (past or current) (84.6% vs 43.1%, p < 0.0001), antipsychotics (38.5% vs 12.6%, p = 0.0018) and NSAIDs (23.1% vs 9.4%, p = 0.043). Users were complicated more frequently by GERD (26.9% vs 8.6%, p = 0.0098) and FD (57.7% vs 24.4%, p = 0.0008). In a multiple regression analysis, age (odds ratio, 1.040 (95%C.I., 1.012 1.068), p = 0.005), current or past CS use (odds ratio, 6.647 (95%C.I., 2.170 20.357), p = 0.001), and having GERD or FD (odds ratio, 3.152 (95%C.I., 1.308 7.599), p = 0.011) were all independently associated with PPI use. Conclusions: PPI users were older and were associated with use of other medications such as CS, antipsychotics, and NSAIDs, as well as upper GI symptoms.

P326 Use of anti-TNF-alpha therapy in Crohn's disease patients in clinical practice: results of a nation-wide survey (named CROSSOVER) conducted in Spain

Background: Recent investigations suggested the association between use of proton pomp inhibitor (PPI), and Clostridium difficile infection and fracture/osteoporosis, which inflammatory bowel disease (IBD) patients are at risk for both. Methods: We investigated the frequency of PPI use and upper gastrointestinal (GI) symptoms, i.e., gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) in IBD outpatients. Participants were invited and agreed to participate in this study at their regular follow-up visit in our institution between June and September 2011. Patients with symptomatic upper GI Crohn’s disease were excluded. A self-administered questionnaire was given to evaluate age, sex, body mass index, smoking history, IBD diagnosis, age at IBD onset, surgical history, current and past IBD medications, use of antipsychotics, NSAIDs, histamine 2 antagonist and PPI. Concomitant GERD and FD were diagnosed by the questionnaire according to Montreal definition and Rome 3 criteria, respectively. Results: Total 272 (164 male and 108 female) patients were evaluated. 193 UC and 78 CD patients were included. Average age was 41.1±15.1 (S.D.) yrs. Disease duration was 6.0 yrs (median). 33 patients (12.2%) had a history of laparotomy. 21 (7.8%) and 67 (24.9%) patients were current and past smokers, respectively. Medications being used were 5-ASA in 184 (67.6%) , corticosteroid (CS) in 9 (3.3%) , immunomodulator in 109 (40.1%) , tacrolimus in 12 (4.4%) , and biologics in 57 (21.0%) patients. GERD and FD were complicated in 28 (10.3%) and 75 (27.6%) patients each. PPI users (n = 26) and non-users (n = 246) were compared. Compared with non-users, users were older (49.1 vs 40.2 yrs, p = 0.004), used more often CS (past or current) (84.6% vs 43.1%, p < 0.0001), antipsychotics (38.5% vs 12.6%, p = 0.0018) and NSAIDs (23.1% vs 9.4%, p = 0.043). Users were complicated more frequently by GERD (26.9% vs 8.6%, p = 0.0098) and FD (57.7% vs 24.4%, p = 0.0008). In a multiple regression analysis, age (odds ratio, 1.040 (95%C.I., 1.012 1.068), p = 0.005), current or past CS use (odds ratio, 6.647 (95%C.I., 2.170 20.357), p = 0.001), and having GERD or FD (odds ratio, 3.152 (95%C.I., 1.308 7.599), p = 0.011) were all independently associated with PPI use. Conclusions: PPI users were older and were associated with use of other medications such as CS, antipsychotics, and NSAIDs, as well as upper GI symptoms.

子宮広間膜裂孔ヘルニアによる絞扼性イレウスの１例

A 41-year-old woman was admitted to our hospital because of lower abdominal pain. She had no history of laparotomy. An abdominal CT scan at the time of admission indicated closed-loop intestinal obstruction of the small intestine within the pelvis and deviation of the uterus to the right. We diagnosed this as a strangulated internal hernia and decided to conduct an emergency operation. The ileum had herniated through a defect in the broad ligament of the uterus. The strangulated intestinal loop, which was about 25cm long, was released, and the defect of the broad ligament was closed. The postoperative course was uneventful. The differential diagnosis of intestinal obstruction should include internal hernia, especially in the absence of a previous laparotomy. An abdominal CT scan is quite useful for the preoperative and prompt diagnosis of internal hernia through a defect in the broad ligament of the uterus.

Descending thoracic aorto bifemoral artery bypass for Aortoiliac occlusive disease :A novel anterior subcutaneous tunnel approach

Descending thoracic aortobifemoral bypass via novel anterior subcutaneous tunnel approach was evaluated in 31 patients. Indications for this approach were; infrarenal aortic block with no site for infrarenal aortic clamping(18 cases), calcified infrarenal aorta(11 cases) and history of laparotomy(2 cases). Duration of surgery was 1.5 to 3 hours and blood loss was 300ml to 1000ml. There was mortality of 2 patients. Reexploration due to bleeding was done in 3 patients and 3 patients required prolonged ventilatory support for 2 days. This approach is recommended in selected patients where conventional approach to the abdominal aorta is not feasible. Follow up of 27 pateints had patent grafts in 24 patients and blocked grafts with no symptoms in 3 patients. 2 patients were lost to follow up.

Laparoscopic Primary Entry for Patients with Previous Laparotomy

We demonstrated safe primary entries for patients with previous laparotomy to avert damage to umbilical-adhesive organs. We used alternative microlaparoscopic approaches via the 9th intercostal space and the posterior vaginal fornix in all patients with a history of abdominal surgery. A 3-mm microtrocar with a Veress needle was inserted via these areas based on the location of the previous wound. After a pneumoperitoneum was created, the abdominal cavity was observed through a microlaparoscope. We performed these approaches for 389 patients with history of laparotomies at our hospital between January 2002 and December 2011.

Double-balloon endoscopy in patients with Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is a rare hereditary syndrome characterized by mucocutaneous pigmentation and hamartomatous polyps of the gastrointestinal tract, especially in the small intestine. Double-balloon endoscopy is a new endoscopic technique that enables both endoscopic visualization of the entire small bowel and therapeutic interventions in a single procedure. In this study, we evaluate the efficacy and safety of double-balloon endoscopy for both treatment and surveillance of patients with Peutz-Jeghers syndrome. We retrospectively evaluated 7 consecutive patients who were referred to Dokuz Eylül University, Gastroenterology Department, with the diagnosis of Peutz-Jeghers syndrome between 2007 and 2010. Patients with Peutz-Jeghers syndrome (M/F: 5/2) underwent a total 31 double-balloon endoscopy procedures: 21 by the oral route, 9 by the anal route, and 1 intraoperatively. All of the patients had a history of laparotomy and small bowel resection due to complications such as invagination and ileus. In 7 patients, we found a total of 110 polyps ≥10 mm in diameter (10-100 mm) and polypectomies were performed in all of them. The only complication was a bleeding after polypectomy, which was controlled by sclerotherapy. In 1 patient, because of the intraabdominal adhesions due to past laparotomies, polypectomy was done by intraoperative endoscopy. In 2 of our patients, we made surveillance colonoscopies, found new polyps in the small intestine, and performed polypectomies. Double-balloon endoscopy is an effective and safe endoscopic technique, and represents a milestone for both treatment and surveillance of patients with Peutz-Jeghers syndrome. Polypectomies made in the small intestine might decrease the complication rate due to these polyps and the need for surgery.

Thickness of Rectus Abdominis Muscle and Abdominal Subcutaneous Fat Tissue in Adult Women: Correlation with Age, Pregnancy, Laparotomy, and Body Mass Index

BackgroundRectus abdominis muscle and abdominal subcutaneous fat tissue are useful for reconstruction of the chest wall, and abdominal, vaginal, and perianal defects. Thus, preoperative evaluation of rectus abdominis muscle and abdominal subcutaneous fat tissue is important. This is a retrospective study that measured the thickness of rectus abdominis muscle and abdominal subcutaneous fat tissue using computed tomography (CT) and analyzed the correlation with the patients' age, gestational history, history of laparotomy, and body mass index (BMI).MethodsA total of 545 adult women were studied. Rectus abdominis muscle and abdominal subcutaneous fat thicknesses were measured with abdominopelvic CT. The results were analyzed to determine if the thickness of the rectus abdominis muscle or subcutaneous fat tissue was significantly correlated with age, number of pregnancies, history of laparotomy, and BMI.ResultsRectus abdominis muscle thicknesses were 9.58 mm (right) and 9.73 mm (left) at the xiphoid level and 10.26 mm (right) and 10.26 mm (left) at the umbilicus level. Subcutaneous fat thicknesses were 24.31 mm (right) and 23.39 mm (left). Rectus abdominismuscle thickness decreased with age and pregnancy. History of laparotomy had a significant negative correlation with rectus abdominis muscle thickness at the xiphoid level. Abdominal subcutaneous fat thickness had no correlation with age, number of pregnancies, or history of laparotomy.ConclusionsAge, gestational history, and history of laparotomy influenced rectus abdominis muscle thickness but did not influence abdominal subcutaneous fat thickness. These results are clinically valuable for planning a rectus abdominis muscle flap and safe elevation of muscle flap.

Clinical features of strangulated small bowel obstruction

The causes of strangulated small bowel obstruction (SSBO) include a fibrous cord, torsion, and internal hernia. We conducted this study to define the clinical features of SSBO. We reviewed the clinical course and preoperative data of 74 patients treated for SSBO in Kumamoto Regional Medical Center between January 2004 and September 2010. Twenty-one patients had no history of laparotomy. Computed tomography (CT) showed high positivity (86.3 %) of closed loops in the involved intestine. Postoperative complications developed in 23 patients, representing a morbidity rate of 31.1 %. Forty-four patients underwent resection of non-viable small intestine (non-viable group), and 30 did not require resection of the intestine (viable group). There were four hospital deaths in the non-viable group. The overall mortality rate and the mortality rate in the non-viable group were 5.4 and 9.1 %, respectively. These findings indicate that SSBO can occur without a history of laparotomy, CT is useful in its diagnosis, and its associated morbidity and mortality are high.

Laparoscopic internal fixation is a viable alternative option for continuous ambulatory peritoneal dialysis catheter insertion

PurposeOne of the major drawbacks of peritoneal dialysis (PD) is catheter migration and dysfunction. Preventing catheter migration is one of the main concerns. We compared laparoscopic internal fixation method with open surgical method for catheter migration rates.MethodsFrom January 2008 to August 2009, PD catheters were inserted by laparoscopic fixation (LF) method in 22 patients and by open surgery (OS) in 32 patients. Clinical data were reviewed retrospectively. The frequency of migration, peritonitis, and other complications were compared. Catheter and patient survival rates were also compared.ResultsThe mean age and sex ratio were not different between groups. Mean follow-up duration was 29.1 months in LF group and 26.1 months in OS group. More patients in LF group (27.3%) had history of laparotomy than in OS group (3.1%) (P = 0.01). The mean operation time was significantly longer in LF group (101.6 ± 30.4 minutes) than in OS group (72.4 ± 26.03 minutes) (P = 0.00). The cumulative incidence of catheter migration was 65.6% in OS group and 13.6% in LF group (P = 0.00). Migration-free catheter survival was higher in LF group (P = 0.001). There were no differences in complication rates between groups. Overall catheter survival was similar (P = 0.93). Patient survival rate at 2 years was not different (P = 0.13).ConclusionLaparoscopic internal fixation of continuous ambulatory peritoneal dialysis catheter significantly reduces migration rates without any addition of complications. Also, laparoscopic technique did not incur patient morbidity or mortality despite the requirement for general endotracheal anesthesia and longer operation time. Therefore, internal fixation can be afforded safely in patients with previous abdominal surgery as either a salvage or preventive measure in patients with repeated catheter migration.

術前診断し得た大網裂孔ヘルニアの一例―本邦報告203例の臨床病理学的検討―

Transomental hernia often develops into strangulated ileus. We report on an 81-year-old man with strangulated ileus due to transomental hernia, diagnosed preoperatively by abdominal CT. The patient was referred to our surgical division because of progressive abdominal pain and vomiting. He had no history of laparotomy. An abdominal CT scan showed dilated small intestinal loops with intraluminal air and strangulated small intestinal loops with engorged mesenteric vessels. We diagnosed this as a strangulated internal hernia due to transomental hernia and conducted an emergency laparotomy. The jejunum had herniated through an abnormal hiatus of the greater omentum to the peritoneal cavity. The strangulated intestinal loop, about 15 cm long, was released and the postoperative course was uneventful. In the absence of a previous laparotomy, the differential diagnosis of intestinal obstruction should include internal hernia. An abdominal CT scan is useful for the preoperative and prompt diagnosis of transomental hernia.

Endovascular aortic repair for spontaneous rupture of a non-aneurysmal infrarenal aorta

We report the case of a patient who underwent an endovascular aortic repair for spontaneous rupture of a non-aneurysmal infrarenal aorta. A 67-year-old male with a diagnosis of infrarenal aortic rupture was referred to our hospital. Preoperative computed tomography showed focal ulcers adjacent to the site of rupture, with no evidence of aneurysm formation, suggesting that this aortic rupture was likely to be associated with perforation of penetrating atheromatous ulceration. Open surgical repair might have carried a high-risk because of the patient's history of laparotomy and respiratory impairment, so endovascular aortic repair was planned. We deployed a Powerlink proximal infrarenal cuff 25-25-75L at the rupture site through the femoral artery, with the additional placement of two extra large Palmaz stents at the proximal and distal sites of the Powerlink stent-graft. Completion angiography showed total exclusion with no endoleaks. The patient was successfully extubated on the third postoperative day and recovered well until he contracted aspiration pneumonia two weeks after surgery. Unfortunately, he eventually died of a non-aortic cause three months after the operation. Endovascular aortic repair may be an alternative to conventional surgical repair for high-risk patients with spontaneous infrarenal aortic rupture.

Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication

This study aims to evaluate the clinical and anatomical factors, particularly pelvic dimensions that influence the difficulty of performing laparoscopic anterior resection for rectal cancer. We studied 50 consecutive patients who underwent laparoscopic anterior resection with double-stapling technique (DST) anastomosis for rectal cancer between January 2006 and February 2010. Staging was performed by computed tomography. Five pelvic dimensions (anteroposterior and transverse diameters of pelvic inlet and outlet, and pelvic depth) were measured using three-dimensional volume-rendering images. We also examined a number of other clinical characteristics, including gender, history of laparotomy, body mass index (BMI), operator, tumor location, tumor depth, nodal involvement, and tumor diameter. Univariate and multivariate analyses were performed to determine the predictive significance of these variables on surgical difficulty based on operative time and intraoperative blood loss. Males had significantly shorter pelvic inlets and outlets and significantly greater pelvic depth than females. However, gender did not significantly affect surgical outcomes, although males did tend to experience greater blood loss. Maximum tumor diameter (p=0.014), BMI (p=0.001), operator (p<0.001), and tumor location (p=0.009) were independent predictors of operative time, which, in turn, was related to intraoperative blood loss (p<0.001). Maximum tumor diameter, BMI, operator experience, and tumor location can be used to predict the operative time required to complete laparoscopic anterior resection with DST anastomosis for rectal cancer, with no correlations between pelvic dimensions and operative time. The difficulty of the procedure was not related to patients' pelvic dimensions, which led us to conclude that "narrow pelvis" is not a contraindication for this surgery. Based on these results, we suggest that laparoscopic anterior resection should be performed by experienced surgeons in patients with large tumors, high BMI, and/or extraperitoneal rectal cancer.

Incisional hernia repair

Introduction: Incisional hernia is a late complication of any abdominal surgery, including both laparotomy and laparoscopic. It occurs at the site of previous incision through weak scar. Hernia occurs as a result of excessive tension and inadequate healing of previous incision which is often associated with surgical site infection or severe bouts of coughing in the early post operative period or injury to the nerve supplying the abdominal wall. This study was performed with objectives to review clinical profile and management of incisional hernia in Tribhuvan University Teaching Hospital (TUTH). Methods: A retrospective study was conducted at TUTH, over the period of 18 month from, Jan 2007 to June 2008. All patients with a history of abdominal surgery with a complaint of swelling over previous incision site were included in this study. Results: Twenty two patients who had undergone hernia repair during the period were included. Mean age of presentation was 47 years with the range of 27 to 80 year. Among them 17 were female and five were male. Among 17 female patients, 15 had history of laparotomy through lower midline incision and two had history of minilaparotomy for tubal ligation. Eleven patients had symptoms less than five years and 11 had more than five years. For 18 cases mesh repair was done while herniorraphy was performed in 4 cases. No complications were observed during one year follow up. Conclusions: Incisional hernia is more common in females after lower midline abdominal surgery. Mesh repair is the ideal recommended treatment except in very small incisional hernia where primary repair can be done.DOI: http://dx.doi.org/10.3126/joim.v32i1.4000Journal of Institute of Medicine, April, 2010; 32:1 pp.34-36