Incisional Hernia Patients Research Articles

Incidence of Incisional Hernias in Patients Operated on for Aneurysm or Occlusive Disease

The purpose of this study was to evaluate the incidence of postoperative incisional hernias after elective open abdominal aortic aneurysm (AAA) repair versus aortofemoral reconstruction. In this open prospective study, 281 patients who underwent elective open AAA or aortofemoral repair were included. All patients were evaluated by clinical examination 1 month after the operation, every 6 months for the next 5 years, and every year thereafter for the presence of an incisional hernia. Mean duration of follow-up was 63.7 months (range, 12-144 months). Seventeen patients (6.2%) were lost to follow-up. The development of a postoperative incisional hernia was recorded and analyzed with regard to the demographic data and the traditional risk factors for atherosclerosis. Statistical analysis was performed using the Kaplan-Meier method and the Cox regression analysis. The development of a postoperative incisional hernia after AAA surgical repair had an incidence of 16.2 per cent versus 7.4 per cent after aortofemoral reconstruction. Patients electively operated on for AAA have a 3.8-fold increase of developing a postoperative incisional hernia over patients operated on for peripheral occlusive disease (POD).

Incidence of abdominal wall hernias in patients undergoing aortic surgery for aneurysm or occlusive disease.

The aim of this study was to compare the incidence of abdominal and incisional hernias in patients with abdominal aortic aneurysm (AAA) versus patients with aortoiliac occlusive disease (AOD). The study included retrospectively 121 patients, who underwent elective aortic surgery due to AAA (n = 63) or AOD (n = 58) in the period between January 1998 and January 2000. The patients were examined for the presence of abdominal hernias upon admission, as well as for the development of incisional hernias on follow-up. The incidence of inguinal hernias was significantly higher in the group AAA (21/6-33.3%) compared to the group with AOD (6/58-10.3%) (p < 0.01). The incidence of other abdominal wall hernias (umbilical, epigastric or miscellaneous hernias) was also significant higher in AAA group. Furthermore, the incidence of inguinal hernias was significantly higher in the subgroup of patients with an aneurysm diameter more than 6 cm (41.5% vs 18.2%, p < 0.05). The mean follow-up of the patients was 1.7 +/- 0.3 years. 7 cases of incisional hernia were noted in the AAA group (11.1%) and only 2 cases in the AOD group (3.4%) (p < 0.05). The size of the aneurysm had no influence on the incidence of incisional hernias in the AAA group. We conclude that there seems to be an increased incidence of abdominal wall hernias as well as postoperative incisional hernias in patients undergoing aortic surgery for aneurysm disease compared with aortoiliac occlusive disease.

Incidence and predisposing factors for incisional hernia in patients with liver transplantation.

Cirrhotic patients who are transplanted have a high risk of developing incisional hernia (IH). We have analysed the incidence and treatment of IH in 465 patients with liver transplantation (LT). In order to find predisposing factors, we compared these patients with a similar group of patients with LT without IH. Fifty-four patients (11.6%) developed an IH. Forty-six of these (85%) were males, and in 37% the entire laparotomy incision was involved. Forty patients have been operated on for the hernia, three by primary repair and 37 (92.5%) with a polypropylene mesh. After a follow-up of 42 months, 6 (15%) IHs recurred. Comparing groups, IH patients were older (P<0.05), of male gender (P<0.001), and received more steroids (P<0.01). The IH rate was not related to suture material. Our rate of IH is perhaps reasonable in these high risk patients. It appears that IH can be reduced if steroids are reduced or avoided. We recommend a large mesh for repair.

Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use?

Background: Wound infection and sepsis leading to incisional hernia development are common after emergency colonic operations. Later on, while being operated on to correct an incisional hernia, most of these patients will need colonic resection or bowel continuity reestablishment. Simultaneous treatment of incisional hernias in patients with colostomy or colonic disease remains a difficult challenge, considering the reluctance of most surgeons to treat both conditions at the same time, especially when prosthetic repair is needed.Study Design: The aim of this study was to analyze the short-term results of patients undergoing colonic resection or bowel continuity reestablishment and simultaneous incisional hernia repair with an onlay polypropylene mesh technique. Over a period of 6 years, 20 patients were operated on for colonic problems associated with incisional hernias, including 8 Hartmanns’ colostomies, 6 colostomies or ileostomies with colonic mucous fistulas, 3 postoperative colocutaneous fistulas, a paracolostomic hernia, a Chagas’ megacolon, and a pseudotumoral diverticulitis. A “rule of three” statistical analysis was used to estimate the maximum risk of adverse effects, concerning mesh-related morbidity, after 1- and 2-year followup.Results: A major complication occurred in a patient who developed an anastomotic leakage and secondary wound infection; the patient was treated with parenteral nutrition and antibiotics. Other complications included a minor wound infection, a seroma, and a chronic sinus. One patient died from postoperative problems unrelated to the surgical technique. The occurrence of postoperative wound infection did not prevent mesh incorporation. Followup ranging from 1 to 7 years detected no hernia recurrences; 13 patients were followed for 2 years or more. Our results suggest that risk of mesh-related morbidity does not exceed 15.8% (3 of 19) within the first year and 23.1% (3 of 13) for 2 years followup, with 95% confidence.Conclusions: We concluded that prosthetic repair of incisional hernias associated with simultaneous colonic operations was possible, allowing abdominal wall anatomy reestablishment. There is no reason to believe that abdominal wall prostheses must be avoided in contaminated operations when an adequate surgical technique is used.

INCISIONAL HERNIA THROUGH NONVERTICAL INCISIONS

Although uncommon, incisional hernia may occur after operations where vertical or paramedian incision is not used. Fifteen patients of incisional hernia through nonvertical incisions in the age group of 22 to 65 years were studied. This included hernia through subcostal incision commonly used for cholecystectomy, gridiron incision, pfannensteil incision and lumbar incisions. Majority of these hernias were due to wound complications and factors which give rise to an increased strain on suture lines. Although the technique for anatomical repair of incisional hernia seems safe and dependable in patients with small defects, but in patients with large musculoaponeurotic defect, prolene mesh hernioplasty has proved successful. In one patient with giant incisional hernia through rooftop incision, large defect was covered with merselene mesh by inlay and onlay technique. After a median follow up of 18 months only one patient (6.6%) developed a recurrence. Merselene mesh has proved to be an excellent material for bridging of wide tissue gaps.

Incisional Hernias in Patients with Aortic Aneurysmal Disease: the Importance of Suture Technique

Objective:to study the rate of incisional hernia at 12 months in patients undergoing abdominal aortic aneurysm repair compared with others undergoing other surgery through midline incisions.Methods:a prospective study of 1023 patients, 85 of these with aneurysmal disease. Wounds were continuously closed and the suture technique was monitored by the suture length to wound length ratio.Results:wound incisions were longer and operations lasted longer in aneurysm patients than in others. Incisional hernia was less common if closure was with a suture length to wound length ratio of at least four. Wounds were closed with a ratio of four or more in 39% (33 of 85) of aneurysm patients and in 59% (546 of 923) of others (p<0.01). In aneurysm patients no wound dehiscence was recorded, the rate of wound infection was low and incisional hernia occurred in the same amount as in others.Conclusions:it is concluded that the rate of incisional hernia is similar in patients with abdominal aortic aneurysmal disease and others. Wounds are closed with a less meticulous suture technique in aneurysm patients.

Transverse abdominal incisions compared with midline incisions for elective infrarenal aortic reconstruction: Predisposition to incisional hernia in patients with increased intraoperative blood loss

Purpose: Both midline and transverse abdominal incisions are used for exposing the infrarenal aorta. Transverse incisions are said to cause less pulmonary and systemic complications, but the claimed advantages may be because most transverse incisions are extraperitoneal, whereas midline incisions are intraperitoneal. This study compares intraperitoneal transverse and midline incisions with respect to perioperative and late complications, especially incisional hernia.Methods: Three hundred twenty-nine patients undergoing infrarenal aortic reconstruction (239 aneurysms; 90 occlusive disease) were analyzed retrospectively according to whether the abdominal wall incision was midline (154 patients) or transverse (175 patients). In all patients, the subsequent dissection was transperitoneal and not retroperitoneal.Results: Perioperative survival rates and intraoperative blood loss were comparable, but the transverse incision tended to be followed by a shorter period of postoperative ileus (p = 0.07), perhaps because the small bowel was not always exteriorized during operation with transverse incisions. Mean time spent in the intensive care unit was not different between the groups, but those with transverse incisions remained in hospital 5 days less than those receiving midline incisions (p = 0.0005). When an aortic graft greater than 18 mm in diameter was used, survival was reduced compared with that after smaller grafts (p = 0.028). At 1 to 6 years follow-up in 235 patients (109 midline; 126 transverse), 35 (14.9%) incisional hernias were detected, with no statistical difference according to incision (16.5% midline; 13.4% transverse). Analysis by univariate and multivariate logistic regression showed that blood loss at operation exceeding 1000 ml increased the risk of later incisional hernia by a factor of 3.07. Wound infection increased the risk of hernia by 3.70.Conclusion: Excess blood loss and wound infection exerted this predisposition to incisional herniation independent of other variables.