Abstract

Background and aims About 10-30% of patients undergoing laparotomy develop an incisional hernia. The aim of this study was to review the experience of incisional hernias at a tertiary institution to determine what factors might improve the outcome of care. Materials and methods All patients with incisional hernias who underwent repair at Derriford Hospital, Plymouth between 2009 and 2011 were included in the study. A retrospective review of elective and emergency cases; operative details of the index procedure and hernia repair; and postoperative events and outcome was performed. Analysis was performed using an Excel pivot table and tests of statistical significance performed using GraphPad Prism. Results There were 205 patients (116 females and 89 males) with an overall mean age of 59.14 years (range 19-95). Eighty percent did not have any radiological imaging whereas 15.7% (defect diameter ± SD 12.93 ± 6.37 cm) underwent CT scan. Twenty (10.8%) patients with an average defect size of 2.81 ± 1.41 cm underwent suture repair of their hernias. One hundred twenty-one (65%) patients had a synthetic mesh whereas 18 (9.7%) had a biological and 27 (14.5%) a mixture of different types of mesh to effect complex repairs. The mesh was inserted by onlay technique in 79.6% compared to sublay in 14.9%. Incisional hernia repair was successful in 92% with 17.6% needing readmission and 10.3% a reoperation. Conclusions There is need for a validated classification system and a robust randomised control trial of incisional hernia repair comparing onlay and sublay techniques as a way of driving improvements in outcomes.

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