Clinical Profile And Management Of Incisional Hernias: An Experience

摘要

Incisional hernia is one of the most common problems that a general surgeon is faced with. More often than not the problem is recurrent and tests the abilities of even the most experienced surgeons. We present our previous experience at repair of incisional hernias along with the analysis of results. A total of 76 patients (27 prospective and 49 retrospective) were studied. Only patients with postoperative incisional hernias and above an age of 15 years were included in the study. We conclude that prolene mesh hernioplasty by onlay technique provides excellent results especially in large sheath defects and recurrent hernias. Introduction Among the major catastrophes that can follow abdominal operations wound infection and wound dehiscence are two of the most serious. These complications are likely to be followed by incisional hernia within months or perhaps a few years.Besides increasing in size with time, an incisional hernia can incarcerate, obstruct, strangulate or cause necrosis and perforation, causing a risk to the patient’s life; hence the need to repair these hernias.Incidence of incisional hernias in the best centres is 10%, the recurrence rate after repair is around 40% but seems to be related to the technique of repair (1).Factors such as obesity, diabetes mellitus, wound infection and lower abdominal incision have a higher rate of incisional hernias and recurrence after repair. Hernias less than 4cm wide have a recurrence rate of 25% compared to 41% for those more than 4 cm wide (2).An incisional hernia can develop in any abdominal incision including the laparoscopic port sites (3). Patients usually complain of a bulge and a dragging sensation aggravated by coughing and straining. Occasionally, the overlying skin may ulcerate causing rupture of the hernia (4). Intestinal obstruction and strangulation are also well known presentations.Surgery is usually required for pain and discomfort or in those hernias which are large and have a small opening with a risk of strangulation (5).