STUDY OF VARIOUS MODALITIES IN MANAGEMENT OF INCISION HERNIA REPAIR

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STUDY OF VARIOUS MODALITIES IN MANAGEMENT OF INCISION HERNIA REPAIR

Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 11

Abstract

BACKGROUND Incisional hernias are a major problem following abdominal surgery and their repairs are among the common surgeries done by a general surgeon.1 Besides the preoperative factors such as anaemia, BMI over 25 kg/m2 and smoking which are leading causes contributing to the development of Incisional hernia, laparotomy performed through the abdominal incision doubles the risk of IH.2 In addition, wound infection, increases the risk of IH formation by 1.9 times.3 If left unattended they may attain large size therefore cause discomfort and lead to the complications like Obstruction, Strangulation, Incarceration increasing the risk of morbidity and mortality.4 Treatment of IH involves further major surgery and the results may be poor, with the recurrence rates of up to 49% reported.5 A wide spectrum of surgical techniques have been developed and recommended ranging from sutured techniques to the various types of prosthetic mesh. MATERIALS AND METHODS 30 patients were studied who presented to emergency department with incisional hernias during August 2014 – September 2016 at Gandhi Medical College and Hospital. All patients underwent definitive treatment. RESULTS From our study it is observed that 1. The maximum cases of incisional hernias presenting to the emergency surgical department were found to be in 51-60 years age group. 2. There was female preponderance. 3. Obstruction is the most common presenting symptom found in 60% of cases followed by irreducibility (33.3%) and strangulation (6.67%). 4. The onset of incisional hernias is more after 10 years following previous surgery. 5. Among 30 patients, bowel was viable in 18 patients (60%) and mesh repair was done in 13 patients. Bowel was gangrenous in 12 patients (40%) and anatomical repair was done in 17 patients. 6. Out of 30, women got infected in 11 patients (36.67%) wound dehiscence noted in 5 patients (16.67%). 7. The recurrence rate was 6.67% with 6 months follow up. CONCLUSION 1. The mean age of presentation with IH is 55.4 years 2. Time lapse between previous surgery and presentation with acute symptoms is more than 10 years. 3. The risk of IH was more in midline vertical type of incision than transverse. 4. The incidence of wound infection, wound dehiscence is low in mesh repair than anatomical repair. PP Mesh can be used in presence of contamination in view of usage of higher antibiotics that prevented the mesh getting infected. Hence contaminated wound is not an absolute contraindication for mesh repair. 5. There were no recurrences in patients treated with mesh in a follow up evaluation of 6 months

Authors and Affiliations

Raghu Rachha, Pavithra Shanmugam, Ravi Vangari, Sivateja Pandi, Suresh Jadi

Keywords

Pain Abdomen Gangrene Anatomical Repair Mesh Repair Wound Infection Incisional Hernia

EP ID EP537945
DOI 10.18410/jebmh/2018/199
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