Incisional hernia: predictive factors, clinical presentation and management

Abstract

Background: Incisional hernia is an iatrogenic complication of abdominal surgery and an important cause of morbidity. It occurs in 11-20% of the patients after abdominal surgery. The present study aimed to evaluate predictive factors associated with causation of incisional hernia, clinical presentation, modalities of management and their post-operative complications.Methods: In a hospital based observational study, the subjects were diagnosed cases of incisional hernias with or without comorbidities undergoing planned or emergency surgeries. Patients unfit for anaesthesia were excluded. Predictive factors studied were multiparity, obesity, diabetes mellitus, postoperative wound infection, retention of urine and cough. Time of onset of incisional hernia after initial abdominal surgery, type of abdominal incision was recorded. Local examination of hernia was done to record the position, size, cough impulse, and reducibility of hernia. Patients were either managed by open or laparoscopic approach which was compared with respect to post-repair complications and recurrence.Results: Total of 64 patients were enrolled with mean age of 48.3 and SD ± 8.82 years. Incisional hernia was more common in middle-aged patients (31-50 yrs) and in females. Majority of hernias have occurred within one year (73.43%) of previous surgery. Commonest predictive factors were midline high BMI (87.5%), multiparity (64.06%), infraumbilical incision (59.37%) and postoperative surgical site infection (56.25%). Laparoscopic repair was done in 5 patients (7.83%) and was not associated with any complications while in rest 59 patients (92.17%) treated by open repair, seroma and SSI were common complications. On mean follow up of 34.8months there was 1 recurrence observed in open onlay repair.Conclusions:Middle age females with multiparity with BMI>25 having midline infraumbilical incision with history of SSI commonly developed incisional hernia in first year of previous surgery. Laparoscopic repair had no complications or recurrence.

A study of etiology, clinical presentation and management of incisional hernia

“…This prospective study was conducted at department of general surgery in tertiary care institute over period of one year. In present study, most of the patients with incisional hernia had reported in fifth decade with mean age of the patient was 44.98 years which is comparable with the other studies [7,8] . Increased incidence above the age of 40 years may be attributed to gradual decrease in abdominal muscle tone with the increasing age.…”

Spontaneous Evisceration of Small Bowel in Incisional Hernia

“…It has been reported most commonly in large incisional hernias or recurrent groin hernias where a thinned-out skin vitiates the mechanism for the evisceration [ 3 ]. It is usually precipitated by a thin hernia sac and atrophic avascular skin, which causes friction and desquamating dermatitis, leading to ulceration and gaping [ 4 ]. The phenomena are propagated by multiple risk factors like bouts of coughing, straining during defecation, heavy weight-lifting, older age, obesity, malignancy and history of wound infection, and repeated wound debridement following initial surgery, which adds on to the causality in the form of a sequential increase in the centrifugal intra-abdominal pressures [ 5 ].…”