Incisional hernia

1973

11 to 20% of patients undergoing abdominal surgery develop incisional hernias.

More than a third of patients are symptomatic.

Up to 40% occur over 1 year after operation.

6-15% develop incarceration and 2% strangulation of the bowel.

Approximately 12% undergo subsequent reoperation of the incisional hernia repair within 5 years after the initial repair and up to 23% at 13 years.

Lower incidence after paramedian incision than after vertical midline incision.

After the first reoperation there is a 23% 5-year reoperation rate.

Patients who undergo laparoscopic repair have fewer recurrences than patients who undergo conventional open repair.

Ore incisional hernias after closure with absorbable sutures than with non-absorbable sutures.

Laparoscopic repairs associated with less postoperative pain and a more rapid return to normal activities.

In a randomized controlled trial comparing laparoscopic with open abdominal wall hernia repair: at eight weeks minor complication rates were much higher in the open surgery group than in the laparoscopic group (45% versus 21%, respectively), with a 19% higher wound infection rate and a 16% higher seroma rate for the open surgery group (Itani KM et al).

In the above study major complications were more frequent in the laparoscopic group compared with the open surgery group, 4.4% versus 1.4%, respectively, and were most attributable to bowel injuries (Itani KM et al).

In the above study there was no difference statistically at two years for recurrent hernia rates at 12.5% for the laparoscopic group and 8.2% for the open surgery group, and quality of life and pain scores were similar.

Laparoscopic repair associated with more technical complexity, complications such as visceral and vascular injuries and longer operative time.

Risk factors include: diabetes, obesity, malignancy wound infection, malnutrition, previous laparotomy, use of corticosteroids, and surgical technique.

Lower incidence of incisional hernia after paramedian incision than after vertical midline incision.

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