CLINICAL STUDY AND MANAGEMENT OF INCISIONAL HERNIAS: OUR EXPERIENCE

Abstract

BACKGROUND: Incisional hernia, by definition represents a breakdown or loss of continuity of a fascial closure. Surgical management of incisional hernias has evolved over the last century. This study was performed to review clinical profile and management of incisional hernia in our institute. AIMS AND OBJECTIVES: To analyze the etiopathogenesis of incisional hernia with respect to patient variable factors, types of surgical intervention. MATERIALS AND METHODS: This a prospective study conducted at our institute between February 2009 and January 2011(24 months). 100 patients were included and followed up for immediate post-operative complications. OBSERVATIONS AND RESULTS: Incisional hernia was found to occur more often in 31-40yr age group,and mostly in females. Most commonly occurred following gynecological operations, lower abdominal incisions, post operative wound infection. Most patients noticed the incisional hernia only 1 to 5 years after the index surgery. Laparoscopic hernioplasty was the most commonly performed surgery. CONCLUSION: In Incisional hernias the choice of operative technique is crucial Incisional hernias occur more often in females as they are more likely to undergo lower abdominal surgeries. Mesh repair is considered superior to anatomical repair alone and we recommend Laparoscopic Hernioplasty as the first line of treatment. INTRODUCTION Incisional hernia is defined as any abdominal wall gap with or without a bulge in the area of a postoperative scar perceptible or palpable by clinical examination or imaging 1 . Also, by definition, it represents a breakdown or loss of continuity of a fascial closure. Ian Aird defines incisional hernia as a diffuse extrusion of peritoneum and abdominal contents through a weak scar of an operation or accidental wound. Incisional hernias occur as a result of excessive tension and inadequate healing of a previous incision, which is often associated with surgical site infection. These hernias enlarge over time, leading to pain, bowel obstruction, incarceration, and strangulation. Obesity, advanced age, malnutrition, ascites, pregnancy, and conditions that increase intra-abdominal pressure are factors that predispose to the development of an incisional hernia 14 . Incisional hernia occurs in 5-11% of patients subjected to abdominal operations 2, 3 . More than 50% of incisional hernias present within first 2 years after primary operation 4,5 . For more than hundred years attempts have been made to develop successful methods for repairing incisional herniae from anatomical repair to laparoscopy, but most attempts were followed by high incidence of recurrence and complications. The number of techniques described for incisional hernia only shows that failure rates are not uncommon and hence the search for an ideal procedure. We analyse the various factors responsible for developing incisional hernia, and the most effective treatment modalities.