Incisional hernias following open gynecological surgery: a population-based study

Abstract

Introduction Incisional hernia is a common and costly complication following abdominal surgery. The incidence of incisional hernia after gynecological surgery is not as well studied as that after general surgery. Materials and methods The Swedish National Quality Register for Gynecological Surgery (GynOp) collects preoperative, intraoperative, and postoperative information regarding gynecological surgery. Data were extracted from 2006 to 2014. The National Patient Register (NPR) contains physicians’ data from both public and private hospitals. Univariate and multivariate Cox proportional hazard analyzes were performed on risk factors. Results Between 2006 and 2014, 39,312 women undergoing open surgery were registered in GynOp. The NPR recorded 526 patients who were diagnosed with or had undergone surgery for incisional hernia. The mean follow-up was 2.8 years. Five years after surgery the cumulative incidence of incisional hernias was 2.0% (95% confidence interval 1.8–2.2%). In multivariate Cox proportional hazard analysis obesity (BMI > 30), age > 60 years, midline incision, smoking, kidney, liver, and pulmonary disease were found to predict an increased risk for incisional hernias (all p < 0.05). Conclusions There is much to be gained if the patient can cease smoking and lose weight before undergoing abdominal surgery. The Pfannenstiel incision results in fewer incisional hernias and should be considered whenever possible.

Incisional hernia after cesarean section: A systematic review

“…Complications caused by incisional hernias are pain [1], negative effect on patients' quality of life and body image [1,2] together with risk of strangulation [1,5] and incarceration [1]. The known risk factors for incisional hernia development in general are surgical site infections [3,5,6], obesity (body mass index > 30) [3,6,7], smoking [7], midline incision [8], and emergency surgery [9,10]. In 2015 the median cesarean section rate in Europe was 27 % with rates up to 57 % when looking at individual countries and the rates of cesarean sections increased with 4 % in Europe from 2010 to 2015 [11].…”

Psoas CT Attenuation and Fatty Infiltration Rate Predict Incisional Hernia After Appendicectomy

“…Nearly 350,000 hernia repairs are performed annually, costing approximately $3 billion dollars in the USA [9]. The main known risk factors for IH development include surgical site infection, obesity, smoking, older age, gender (mostly reported as female), hypertension, diabetes, and use of corticosteroids [10][11][12][13][14].…”

Iatrogenic Bowel Injuries During Gynaecological Surgery: A Case Report and Literature Review

“…Electrocautery is erroneously used as an alternative to simple suture when a defect is located on the serosa of the intestinal wall, increasing the likelihood of late intestinal perforation. However, histological changes in coagulation necrosis are evident only a few hours after ischemic injury, with degenerative changes in cells and their necrosis manifesting within one week, sometimes even after several months [9][10][11].…”

“…Pfannenstiel laparotomy is associated with a lower incidence of herniation than midline laparotomy [1,6,12,13]. Hernias may occur when the fascia is not sutured, namely of 10 mm ports or lager, at the end of the laparoscopy [9,12,14]. Callery et al recommend suturing any fascial defect larger than 5 mm in all layers, including the peritoneum.…”

“…Callery et al recommend suturing any fascial defect larger than 5 mm in all layers, including the peritoneum. This reduces the incidence of hernia from 1.83% to 0.17% [9] . Bowel lesions can also occur when the uterine wall is perforated during curettage.…”