Incisional Hernia- Management, Epidemiology, Complication- An In-depth Analysis

Abstract

Background: Incisional hernia is defined as any abdominal wall gap with or without bulge in a postoperative scar perceptible or palpable by clinical examination or imaging. It complicates 5-11% of all abdominal surgeries as reported by various studies.Incisional hernia repair has evolved over the last century, with a humble anatomical repair to mesh repair and now to laparoscopic and robotic meshplasty.Objectives: To analyse the various etiological factors of incisional hernia, the incidence rates for age and sex, therapeutic modalities (anatomical repair and meshplasty) and to study the immediate postoperative complications. Materials & methods: A prospective study was carried out at Narayanahrudayalaya institute of medical sciences Bangalore, between May 2017 and April 2018 involving 72 patients with approval from the Institutional ethics committee. Patients presenting to the General surgery department and emergency in our tertiary center with swelling in the abdomen after undergoing surgical treatment are included in this study.Results: Incisional hernia was found to occur more often in the 5th decade, females (2.6 times more than males), and housewives (53.3%), obese (53.3%). Most patients noticed the incisional hernia only 1 to 3 years after the index surgery. A combination of mesh repair along with anatomical repair was carried out in 63 of the 72 patients including both open and laparoscopic repair and anatomical repair alone in 9 patients. Suction drains were placed in all patients who underwent mesh repair and were associated with fewer immediate post-operative complications.Conclusion:Incisional hernias occur more often in females as they are more likely to undergo lower abdominal surgeries (gynaecological). The incidence was higher if the patients had post-operative wound infection or dehiscence following the index surgery, had associated risk factors such as chronic cough, constipation, voiding difficulties. Interestingly the tone of abdominal muscles did not play an important role in the incidence of incisional hernia in our study. Mesh repair was deemed superior to anatomical repair alone as post-operative complications were lesser. There were no recurrences during our follow up period, albeit a longer follow up is required to draw definitive conclusions.