Outcome of Combining Ventral Hernia Repair with Abdominoplasty or Mesh-abdominoplasty in Multiparous Women

摘要

Objectives: to determine the outcome of ventral hernia repair during abdominoplasty and mesh-abdominoplasty regarding cosmesis, recurrence and post-operative complications. Subjects and Methods: The present retrospective study included 78 multiparous women with ventral hernia and abdominal wall deformity. Age ranged between 28 and 59 years with a mean of 41.37±11.18 years. Half of the patients suffered from episodes of colicky abdominal pain and 34 (43.6%) had chronic low back pain. Forty patients (with defect < 3cm) underwent standard abdominoplasty (Group 1) and 38 (with defect > 3cm) underwent mesh-abdominoplasty (Group 2), both after primary suture hernia repair and midline fascial plication. The follow-up period ranged from 22 months to 11 years with a mean of 62.5 months. Results: Both groups were comparable regarding their demographic and clinical parameters. Patients with abdominoplasty had significantly (p=0.0193) more para-umbilical hernias (PUHs) than those with mesh-abdominoplasty (80% vs 55.3%, respectively), but had less incisional or recurrent PUHs. All repaired hernias did not recur except for one patient in each group. No mortality or major complications were encountered. Wound complications occurred in 7 patients (17.5%) in Group 1 vs 10 (26.3%) in Group 2 (p=0.346). Recurrence of abdominal wall deformity and the need for a second refashioning procedure were significantly higher among patients who underwent abdominoplasty alone (p=0.011 and p=0.0139, respectively). Conclusions: (1) During abdominoplasty, ventral hernia repair and midline plication can be performed in defects 3 cm, additional mesh reinforcement is indicated and (3) Prolene mesh-abdominoplasty for multiparous women with severe musculo-aponeurotic laxity and ventral hernia, yields lower recurrence of abdominal deformity and less refashioning procedures with minimal complications than abdominoplasty alone.