A comprehensive study on the incidence and management of incisional hernia

Background: Incisional hernia is a frequent complication of abdominal surgery. The reported incidence of incisional hernia following abdominal surgery ranges from 2-20%. It may be caused by flawed operative techniques, by postoperative complications such as wound infection, by increased abdominal wall tension or by a metabolic connective tissue disorder.Methods: The present study was conducted on patients of incisional hernias admitted in various surgical wards of the department of surgery, associated group of hospitals attached to Dr. Sampurnanand Medical College, Jodhpur over a period of 10 years extending from 2005 to 2015. Detailed history and clinical examination of all patients were obtained from the case sheets. Other risk factors like obesity, hypertension, diabetes mellitus and malignant disease were recorded. Routine investigations were also documented. Patients were closely monitored in pre, intra and post-operative periods. The data collected were systemically recorded and statistically analysed.Results: Maximum incidence (67.21%) of incisional hernia seen in 31-60years of age and mean age was 48.54years with twice common in female sex. Abdominal swelling was the commonest (90.57%) presenting symptom. 80% of patients present within 1 year. Of previous surgery, 50% of them were gynaecological. Midline vertical incision (70%) was most notorious to develop in incisional hernia. Wound infection (50%) was major risk factor. Mesh repair (laproscopic 3.68% & open 92%) was the procedure of choice.Conclusions: Incisional hernia is twice common in women than in men with gynaecological procedures mainly caesarean section contributing for half of the cases of incisional hernias. It more frequently develops in vertical midline incision and post-operative wound infection is the most important predisposing factor. Incisional hernia usually appears within 1 year of previous operation. Mesh repair of incisional hernia has of late become popular amongst surgeons.

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Distribution and Determinant of Post-Operative Wound Infection among Patients underwent Routine Abdominal Surgery

Bangladesh Journal of Infectious Diseases ◽

10.3329/bjid.v6i1.42661 ◽

2019 ◽

Vol 6 (1) ◽

pp. 16-21

Author(s):

Md Mafiur Rahman ◽

SM Shafiul Azam Chaudhury ◽

Md Atiqul Islam ◽

Mohammad Khurshidul Alam ◽

ABM Mir Mubinul Islam ◽

...

Keyword(s):

Abdominal Surgery ◽

Wound Infection ◽

Infection Rate ◽

Wound Infection Rate ◽

Operation Theatre ◽

Medical College ◽

Abdominal Operations ◽

Contaminated Wound ◽

Clean Contaminated ◽

Operative Wound

Background: Post-operative wound infection may occur after routine abdominal surgery. Objective: The purpose of the present study was to see the distribution and determinants of post-operative wound infection among the patients underwent routine abdominal surgery. Methodology: This non-randomized clinical trial was conducted in the different surgical units of the Department of Surgery at Sir Sallimullah Medical College & Mitford Hospital, Dhaka, Bangladesh during January 2001 to December 2002 for a period of two (02) years. In the operation theatre, after anaesthesia skin was cleaned with Povidone iodine USP 5% w/w or Spirit (70% methylated spirit in water) or Chlorhexidine. During post-operative period dressing were left undisturbed unless it was felt necessary. Unusual pain in and around the wound was considered to be an indication of infection. A swab was taken from any discharge and was sent for bacteriological examination. Result: In this study, 50 patients were admitted as routine cases and undergone routine abdominal operations in general operation theatre. Out of 50 patients undergone routine abdominal surgery, 5 developed wound infection post operatively. Overall infection rate was 10.0%. In routine abdominal operations, infection was 9.09% in upper midline or extended midline incision, 33.33% in lower midline, 6.25% right subcostal/Kocher's. In routine abdominal operations, the rate of infection in clean contaminated wound was 11.11%, contaminated wound was 33.33%. Wound infection rate was 20.0% cases in patients with malnutrition, 14.28% cases in obesity and 16.66% cases in diabetes mellitus. Conclusion: In conclusion post-operative wound infection is common in routine surgical operation. Bangladesh Journal of Infectious Diseases, June 2019;6(1):16-21

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Incidence of incisional hernia with respect to different sites and causes

International Surgery Journal ◽

10.18203/2349-2902.isj20203231 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2539

Author(s):

Shahaji G. Chavan ◽

Saladi Naga Nithin ◽

Karan Jaiswal ◽

Manasa Rambatla

Keyword(s):

Incisional Hernia ◽

Rectus Sheath ◽

P Value ◽

Inclusion Criteria ◽

Previous Surgery ◽

Incisional Hernias ◽

Medical College ◽

Primary Surgery ◽

Posterior Rectus Sheath ◽

A Prospective Study

Background: Of all hernias encountered, incisional hernias can be the most frustrating and difficult to treat. The aim of this study is to find out the incidence of incisional hernia at different sites and to find out their possible causes.Methods: This was a prospective study of 50 cases of Incisional hernias admitted during the period between July 2017 to July 2019. Collected data is analysed over a period of 3 months. Patients with Incisional hernia satisfying the inclusion criteria, attending surgery OPD at Dr. D. Y. Patil Medical College, Pimpri, Pune were included in study group.Results: Mean age at presentation was 45 (32/50) were female 18 patients were male. Majority of the patients were obese. Infra-umbilical variety of incisional hernia is most common 42%. The most common primary surgery is tubal ligation was 14 (28%). Significant association noted between diabetes mellitus and SSI, p value <0.05. There is a significant association between addictions (tobacco, smoking and alcohol) and hernias in umbilical region and above p value <0.005.Conclusions: The incidence of incisional hernia is more in multiparous females. Infra-umbilical midline was the most common site for herniation in 42% of cases. Lower midline incisions are more prone for herniation as the posterior rectus sheath is deficient below arcuate line. The most common previous surgery was tubectomy 14. Diabetes and SSI played important role in causing incisional hernia in our study.

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HERNIOPLASTY

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.02.2907 ◽

2009 ◽

Vol 16 (02) ◽

pp. 224-227

Author(s):

MUHAMMAD FAISAL BILALL ◽

MUHAMMAD AKRAM ◽

SUMERA KANWAL ◽

Jawaid Iqbal

Keyword(s):

Incisional Hernia ◽

Wound Infection ◽

Mesh Repair ◽

Enterocutaneous Fistula ◽

Tertiary Care ◽

Rectus Sheath ◽

Fistula Formation ◽

Open Mesh Repair ◽

Sublay Technique ◽

Open Mesh

Incisional hernia is a common complication of abdominal surgery and an important source of morbidity. It may be repairedusing open suture, open mesh or laparoscopic mesh techniques. O b j e c t i v e s : To examine the results of open mesh repair using "sublaytechnique" of hernioplasty. Setting: Surgical Unit-I, Department of Surgery at Allied Hospital, a tertiary care teaching hospital affiliated withPunjab Medical College, Faisalabad. Patient & M e t h o d s : Sixty patients (male:16, female:44) were operated for incisional hernia. Openmesh repair was done. Polypropylene mesh was placed over closed posterior rectus sheath layer and over the rectus abdominis, wereavailable. Anterior rectus sheath was closed in front of the implanted mesh. All the patients received injectable third generation cephalosporinfor 48hrs postoperatively. Postoperative recovery in terms of seroma formation, wound infection, intraabdominal adhesions leading tointestinal obstruction, enterocutaneous fistula formation and recurrence were the main factors noted and analyzed statistically. Results:Mean postoperative hospital stay was 03 days. Only one patient developed wound infection. None of the patients developed seromaformation, intestinal obstruction or enterocutaneous fistula. Maximum follow up till this study is 14 months. No recurrence has been reportedso far. C o n c l u s i o n s : Open mesh repair using "sublay technique" does not carry risk of enterocutaneous fistula, carries low risk of seromaformation and wound infection. Proper technique is not associated with recurrence.

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Comparison of Post-Operative Complications Between Sublay and Onlay Mesh Repair in Incisional Hernia

10.53350/pjmhs2115123384 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3384-3386

Author(s):

Azizullah Khan Sherani ◽

Saleem Javed ◽

Muhammad Idrees Achackzai

Keyword(s):

Incisional Hernia ◽

Wound Infection ◽

Mesh Repair ◽

Seroma Formation ◽

Onlay Technique ◽

Sublay Technique ◽

Operative Complications ◽

Group A ◽

Group B ◽

Post Operative Complications

Objective: To compare the post-operative complications between sublay and onlay mesh repair in incisional hernia. Materials & Methods: This randomized controlled trial was conducted at Department of Surgery, Sandeman Provincial Hospital Quetta from May 2019 to November 2019. Total 250 patients with incisional hernias for more than 3 months, having age 20-40 years either male or female were selected. Then selected patients were placed randomly into two groups i.e. Group A (Sublay group) & Group B (Onlay group), by using lottery method. Patients were called for follow up 15th day for post-operative complications in term of wound infection and seroma formation. Results: The mean age of patients in group A was 34.73 ± 4.32 years and in group B was 34.51 ± 4.67 years. Out of these 250 patients, 161 (64.40%) were female and 89 (35.60%) were males with female to male ratio of 1.8:1. Wound infection was seen in 07 (5.60%) patients in group A (Sublay technique) and 17 (13.60%) patients in group B (Onlay technique) with p-value of 0.033. Seroma formation was seen in 09 (7.20%) patients in group A (Sublay technique) and 26 (20.80%) patients in group B (Onlay technique) with p-value of 0.002. Conclusion: This study concluded that rate of wound infection and seroma formation is less after sublay mesh repair for incisional hernia as compared to onlay repair. Keywords: Hernia, incisional, onlay, sublay, seroma.

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Analysis of Risk Factors for Incisional Hernias and its Management

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v10i2.20803 ◽

2018 ◽

Vol 10 (2) ◽

pp. 16-20

Author(s):

S R Paudel ◽

B R Neupane ◽

N V Gurung ◽

A Acharya ◽

A Chapagain ◽

...

Keyword(s):

Risk Factors ◽

Incisional Hernia ◽

Wound Infection ◽

Mesh Repair ◽

City Hospital ◽

Midline Incision ◽

Primary Surgery ◽

Western Regional ◽

One Year ◽

Age Range

Introduction: Incisional hernia is a common problem after abdominal surgery. Patients present with pain, swelling and intestinal obstruction. It may be repaired by either anatomical suturing or mesh repair.Methods: It is a prospective observational study conducted in Western Regional Hospital and Fewa City Hospital, Pokhara from 2013 to 2016. A total of consecutive 100 patients admitted in these hospitals during the study period were included.Results: Incisional hernia is more common in females (M : F = 1 : 3.8), and in 30 - 50 years age group (60%). Major risk factors were wound infection (30%), overweight (25%), and postoperative cough (10%). It is found to be more associated with gynecological (65%), than gastrointestinal operations, and more so with lower abdominal midline incision (65%). It is found to occur mostly within one year (60%) of primary surgery than later. Even 24% of the patients had first symptom within six months. Mesh repair (92%) was the preferred standard surgical treatment for incisional hernia.Conclusion: Overweight females of age range between 30 - 50 years with history of gynecological operations by lower abdominal midline incision are more prone to develop incisional hernia. This incidence increases when there is wound infection. Mesh repair is the choice of operation for incisional hernia. J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 16-20

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VENTRAL INCISIONAL HERNIAS

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.02.2057 ◽

2011 ◽

Vol 18 (02) ◽

pp. 228-232

Author(s):

HAROON JAVAID MAJID ◽

HARUN MAJID DAR ◽

MUHAMMAD SHAFI ◽

Muhammad Arif Javed

Keyword(s):

Incisional Hernia ◽

Mesh Repair ◽

Randomized Clinical Trials ◽

Incisional Hernia Repair ◽

Suture Repair ◽

Recurrence Rates ◽

Incisional Hernias ◽

Number Of Patients ◽

Open Mesh Repair ◽

Ventral Incisional Hernia

Ventral Incisional Hernias are a well known complication after abdominal surgery with a reported incidence of 10% - 20% and a recurrence rate of 30% - 50% after open suture repair and less than 10% after open mesh repair. Objectives: To compare the outcome of two different methods of open repair of VIH (i.e. Mesh versus Non-mesh or Suture Repair in terms of morbidity, complications and recurrence. Period: 11 years period (January 2000 – December 2010). Setting: Shaikh Zayed Hospital, Lahore. Patients & Methods: The total number of patients who underwent surgery for repair of VIH during the study period was 321.There were only 33 patients in Group A (simple suture/Keel repair) while Group B had 288 patients. The most common early postoperative complications seen in both the groups were wound seroma and infection. Post-operative respiratory insufficiency was more common in the obese. Chronic pain and feeling of foreign body was more frequently seen in the mesh group. On the other hand, recurrence rates were far greater in the suture repair group. The overall mortality in the whole series was 3 patients (0.93%). Conclusions: The rates of ventral incisional hernia recurrence and complications are significantly lower after open onlay mesh repair as compared to the open suture repair. However, these results require confirmation by prospective randomized clinical trials which should also include the results of laparoscopic ventral incisional hernia repair which is a new and emerging technique in Pakistan.

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INTRAPERITONEAL MESH PLASTY

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.03.2473 ◽

2010 ◽

Vol 17 (03) ◽

pp. 360-365

Author(s):

FAKHAR ILYAS MALIK ◽

TAHIR IQBAL MIRZA

Keyword(s):

Incisional Hernia ◽

Polypropylene Mesh ◽

Mesh Repair ◽

Operating Time ◽

Mesh Placement ◽

Incisional Hernias ◽

Intraperitoneal Mesh ◽

Intraperitoneal Mesh Placement ◽

Morbid Conditions

Background: Incisional hernia is a common surgical condition with a reported incidence of 2-11% following laparotomy. Various Modalities of Repair have been advocated but the overall results still remain disappointing. Objective: To evaluate in incisional Hernias the efficacy and safety of Intraperitoneal mesh repair with conventional Polypropylene Mesh. Setting: In CMH Muzaffarabad, CMH Sialkot and PAC Hospital Kamra. Period: From January 2000 to January 2007. Materials & Methods: 90 cases of Incisional hernia with a minimal defect size of 4 inches were included; there was no limitation to age and sex. Patients with Co morbid conditions like Diabetes Mellitus, Hypertension, Bronchial Asthma, and Ischemic Heart Disease etc: were also included if there was no other contraindications for Surgery. Observations were made with regard to duration and ease of the operation, wound complications, hospital stay, recurrence and delayed complications. Results: In our series of 90 patients, Females (92.22%, n= 83) outnumbered males (7.77%, n=7) and the highest incidence was in the 4th decade of life in females and the 3rd decade of life in males. Gynecological operations accounted for 61.44% (n=51) of the index operations. 77.7% (n=70) ofpatients had a BMI >30. Co morbid Conditions were present in 36.66% (n=33) of patients. The polypropylene mesh placed Intra peritoneal varied from 15×7.5 cm to 30×20 cm. The mean operating time was 60±20 minutes; operating time was extended when the procedure was accompanied by Dermolipectomy 80±10 minutes. 85.55% patients (n=77) attended our follow-up, ranging from 12 months to five years.Method of follow-up in outpatients department (OPD)/Clinics: 71.11%(n=64), by telephonic conversation: 12.22%(n=11). 14.44% (n=13) were lost in follow up. All patients in followup had serial abdominal sonograms at 3, 6, 9 and 12 months postoperatively respectively to evaluate bowel motility, adhesion formation and any locally associated complication. No recurrence was noted in the follow-up group. Conclusions:Historically intraperitoneal Mesh placement of conventional polypropylene has been avoided as it was associated with significant postoperative complications. Based on our analysis, we believe that intraperitoneal mesh repair is still an effective option for Incisional hernias, especially in difficult cases and with patients having co morbid conditions. The associated high incidence of complications associated with intraperitoneal mesh placement in the literature were not seen in our experience.

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Preperitoneal mesh repair in incisional hernia: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20205346 ◽

2020 ◽

Vol 7 (12) ◽

pp. 3994

Author(s):

Uma Dhanasekaran ◽

Ramesh Arumugam

Keyword(s):

Incisional Hernia ◽

Prospective Study ◽

Polypropylene Mesh ◽

Mesh Repair ◽

Incisional Hernias ◽

Post Surgery ◽

Operative Complications ◽

A Prospective Study ◽

Post Operative Complications

Background: Incisional hernia is a common surgical condition encountered in day to day practice. Based on national operative statistics, incisional hernias account for 15 to 20% of all abdominal wall hernias. Of all hernias encountered incisional hernias can be the most frustrating and challenging to treat. This prospective study aims to assess the efficacy of preperitoneal mesh repair technique using polypropylene mesh in the management of incisional hernia.Methods: A total of 40 patients with incisional hernia undergone open preperitoneal polypropylene mesh repair. It had evaluated for post-operative complications and recurrence for six months to one-year post-surgery. The results had tabulated statistically analysed and compared with other published reports in the literature.Results: Out of 40 patients, the size of the defect, 10 patients had less than 2 cm, 28 patients had between 2.1-4 cm, 1 patient between 4.1-6 cm and 1 patient between 6.1-8 cm. The type of hernia, 32 patients had infra umbilical hernia, and 8 patients had a supraumbilical hernia. Post-operative complication 3 patients had seroma, 1 patient had edge necrosis, 1 patient had post-op ileus, and 1 patient had chronic pain. Based on follow up, 4 patients had followed until 6 months, 10 patients till 9 months and 26 patients till one year.Conclusions: Post-operative complications following open preperitoneal polypropylene mesh repair are considerably less compared to other techniques of mesh repair and showed no recurrence among its subjects during the follow-up period, and longer follow-up is required to draw a definitive conclusion.

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Clinical study and management of incisional hernias: a prospective monocenter experience

International Surgery Journal ◽

10.18203/2349-2902.isj20171616 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1657

Author(s):

Santoshkumar N. Deshmukh ◽

Anagha S. Varudkar ◽

Anant V. Chopde

Keyword(s):

Incisional Hernia ◽

Wound Infection ◽

Suture Material ◽

Tertiary Care ◽

Female Ratio ◽

Factors Affecting ◽

Incisional Hernias ◽

Post Operative Period ◽

And Gender ◽

Male To Female

Background: Incisional hernia is the most frequent postoperative complication following abdominal surgery. Several studies have shown that incisional hernias have different etiologies which are related to the patient, the surgical technique, the suture material, and experience of the surgeon. Aim of present study was to assess the magnitude of problem, analyse various factors leading to development of this condition, different modalities of treatment practiced, postoperative complications, various factors affecting surgical outcome in these patients.Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital at Solapur, Maharashtra, India from January 2014 to December 2016. All the patients, regardless of age and gender, admitted with diagnosis of incisional hernia were included in the study. Depending upon the size of defect treatment was carried out. Postoperatively patients were followed up for detection of possible complications and their treatment.Results: Total 50 patients of incisional hernia were studied. Mean age was 46 years with male to female ratio 4.5:1 wound infection in the post-operative period was the commonest etiology noted followed by obesity.Conclusions: Wound infection following previous surgery was the most important risk factor associated with incisional hernia. The other risk factors were obesity and COPD. Polypropylene mesh repair is superior to anatomical repair as it has less recurrence.

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Physiology in Medicine: physiological basis of diaphragmatic dysfunction with abdominal hernias–implications for therapy

Journal of Applied Physiology ◽

10.1152/japplphysiol.00276.2014 ◽

2015 ◽

Vol 118 (2) ◽

pp. 142-147 ◽

Cited By ~ 6

Author(s):

Patrick Koo ◽

Eric J. Gartman ◽

Jigme M. Sethi ◽

F. Dennis McCool

Keyword(s):

Abdominal Surgery ◽

Incisional Hernia ◽

Abdominal Wall ◽

Common Complication ◽

Diaphragmatic Dysfunction ◽

Physiological Basis ◽

Diaphragm Dysfunction ◽

Incisional Hernias ◽

Abdominal Hernias ◽

Diaphragm Function

An incisional hernia is a common complication after abdominal surgery. Complaints of dyspnea in this population may be attributed to cardiopulmonary dysfunction or deconditioning. Large abdominal incisional hernias, however, may cause diaphragm dysfunction and result in dyspnea, which is more pronounced when standing (platypnea). The use of an abdominal binder may alleviate platypnea in this population. We discuss the link between diaphragm dysfunction and the lack of abdominal wall integrity and how abdominal wall support partially restores diaphragm function.

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