Study of incisional hernia: Evaluation of risk factors and outcome of various surgical techniques used in the incisional hernia repair

BACKGROUND AND OBJECTIVES: Incisional hernia is defined by the European hernia society as ”any abdominal wall gap with or without a bulge in the area of postoperative scar perceptible or palpable by clinical examination or imaging”. Development of Incisional Hernia can follow any type of surgical incision, whatever its site or size, even the incision of the laparoscope trocar can cause it. Incisional Hernia was reported as a complication of abdominal surgery since the early days of surgery, Greedy (1836) and Maydl (1886) reported repair of Incisional Hernia, Judd (1912) and Gibbon(1920) described the anatomical repair of Incisional Hernia ,Kirschner (1910) introduced the auto graft (fascia lat, skin) and hetero graft (skin) for repairing Incisional Hernia. The incidence of Incisional Hernia is still high, in spite of the great improvement in the techniques and suture materials used for closing the abdominal wall incisions. Many procedures and techniques were described for preventing and repairing Incisional Hernia; using different suture materials, suture repair, prosthetic repair, combination of different techniques or laparoscope. In spite of the many efforts for reducing the incidence of Incisional hernia, still there is a lack of consensus regarding the best approach for preventing and repairing Incisional Hernia, because most of them are followed by complications. Incisional Hernia represents a major surgical issue for surgeons of all specialties. This study was a prospective analytical study done to evaluate the risk factors associated with Incisional Hernia to develop a strategy for an effective management of Incisional Hernia by studying the outcomes of various techniques in the incisional hernia repair and to study the post-operative morbidity of various surgical techniques. METHODS : This study of incisional hernia- evaluation of risk factors and outcome of various surgical techniques used in the incisional hernia repair is a Prospective comparative analytical study and the data is obtained from patients who consented to get operated for Incisional Hernia at Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai for a period of 8months February 2017 to September 2017(8 months) in 50 patients aged between 18- 70 years. All the patients are evaluated by proper history and detailed physical examination. Data collected by proforma. All patients underwent routine blood investigations and in our study. Ultrasound abdomen done for all our patients to know the size, number of defects, contents and any other abdominal Pathology. In onlay repair polypropylene mesh is sutured over the anterior rectus sheath, while in sublay technique mesh is placed under retro-rectus muscle position. The wounds were inspected for any seroma, hematoma or any infections. In open group, drains were removed when the collection was less the 30 ml for 2 consecutive days. Patients were discharged after complete ambulation and tolerating normal diet. The Statistical software namely SAS 9.3, SPSS 15.0 were used for the analysis of the data and Microsoft Word and Excel have been used to generate graphs, tables etc. RESULTS : In our study, most of the patients more than 60%, underwent incisional hernia surgery between the age of 30 to 50 years. Of these, most of the patients are in the age group of 30 to 40 years. This shows most of the patients are in the middle age group. In our study, out of the fifty patients in incisional hernia repair, 10 patients (20%) are male. While 40 patients (80%) are female. This shows females are more prone for incisional hernia. Most of the patients undergone previous surgery under the age of 30 years (48%). 13 patients (26%) were between the 30 to 40 years of age. The rest 13 patients (26%) were above 40 years of age. This shows that the patients undergone surgery in young age group are prone for incisional hernia. Many of the patients are having history of previous wound infection in previous surgery noted in our study. Drain removal was done after five days for 34 patients (68%) and within five days for 16 patients (32%). This shows duration of stay increased in onlay mesh repair due to delayed drain removal. In the present study, post-operative complications of onlay and sublay compared. Seroma rate is 39%, wound infection is 20%, wound dehiscence is 22%, secondary suturing done in 19% of the patients. From this, sublay repair is having minimal number of complications CONCLUSION : A study consisting of 50 patents who underwent incisional hernia repair by onlay and sublay method in Madras Medical College and evaluating outcomes of onlay and sublay surgical techniques in Madras Medical College, preperitoneal sublay repair was found to have better patient compliance and satisfaction with regard to occurrence of complications. The preperitoneal sublay repair procedure can easily be performed by a surgeon with proper guidance and has a short learning curve.