Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery

Abstract

Background: This study aims to investigate incisional hernia incidence and risk factors after abdominal aortic aneurysm and aortic occlusive disease surgery via a midline laparotomy. Methods: A total of 110 patients (66 males, 44 females; mean age: 69.3±8.8 years; range, 36 to 88 years) who underwent open elective surgery for aortoiliac occlusive diseases or abdominal aortic aneurysm between January 2005 and December 2016 were retrospectively analyzed. Both patient groups were compared in terms of surgical procedures, sex, age, American Society o f A nesthesiologists s core ( 1-3), b ody m ass i ndex (<25 vs. ≥25 kg/m2), smoking (non-smoker <1 pack/day, smoking ≥1 pack/day), and time to incisional hernia development. Results: Incisional hernia occurred in 14.3% of the patients operated for aortoiliac occlusive disease and in 17.6% of the patients operated for abdominal aortic aneurysm (p=0.643). Incisional hernia was seen in three (5.7%) of 53 patients with a body mass index of <25 kg/m2 and was in 15 (26.3%) of 57 patients with a body mass index of ≥25 kg/m2 (p=0.03). Conclusion: High body mass index is a risk factor for incisional hernia in patients undergoing aortic reconstructive surgery.

Incisional Hernias after Vascular Surgery for Aortoiliac Aneurysm and Aortoiliac Occlusive Arterial Disease: Has Prophylactic Mesh Changed This Scenario?

“…7,8,21 In a study comparing AAA and AOD repair, a BMI of 25 kg/m 2 or higher was found to be an independent risk factor for IH. 10 Obesity is associated with a higher intraabdominal pressure and wound-healing complications as a consequence of decreased vascularity of adipose tissue. The synthesis of mature collagen is impaired in hypoxic wounds, resulting in weakened tissue formation.…”

“…Although collagen tissue composition, genetic mutation, clear biological indicator, or significant relationship between risk factors have not yet been fully elucidated in AAA formation and abdominal wall hernias, it is believed that an underlying imbalance between collagen Type 1 and 3 is the common point in the pathophysiology of these conditions. 2,7,10,20 There are a few studies in the literature that compare the groups in terms of IH development between AAA and AOD, and it has been reported that the AAA group has a greater IH rate, up to a median of 5-fold increased risk. 7,8,21 In a study comparing AAA and AOD repair, a BMI of 25 kg/m 2 or higher was found to be an independent risk factor for IH.…”

“…The hypothesis of a higher incidence of hernias among patients undergoing AAA repair is based on the probable systemic disease of the connective tissue, a condition that is not present in AOD, where the cumulative incidence ranges between 3 and 17%. 2,3,10 IH has a considerable negative socioeconomic and medical effect. Intestinal obstruction, strangulation, and perforation can happen as a consequence of IH, and emergency surgery may be necessary with an increased risk of mortality.…”

“…The hypothesis of a higher incidence of hernias among patients undergoing AAA repair is based on the probable systemic disease of the connective tissue, a condition that is not present in AOD, where the cumulative incidence ranges between 3 and 17%. 2 3 10 …”

“…Not all studies found a significant difference in the incidence of IH between patients undergoing AAA and AOD surgery. 10 Thus, our goal is to identify whether there is a benefit of the prophylactic reinforcement of the mesh after the surgical treatment of AAA in the reality of our patients.…”