A Prospective Study To Assess Causes And Complications Of Incisional Hernia In Patients Coming To Vmkvmch

Abstract

Introduction: Incisional hernia (IH) is defined as any abdominal wall defect with or without swelling in the area of a postoperative scar palpable by clinical examination or imaging. Every year there are approximately 4 million abdominal operations are being performed and the reported incidence of incisional hernia following abdominal surgery ranges from 11-20%. Unlike other abdominal wall hernias, which occur through anatomical points of weakness, incisional hernias occur through a weakness at the site of abdominal wall closure.

Materials and methods: A descriptive prospective observational study was conducted in Department of General Surgery, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem over a period from August 2021 to July 2022 with 102 patients included in the study. Observations were made with regard to duration and ease of operation, wound complications, mesh infections, hospital stay, morbidity and recurrence. Diagnosis was made with clinical examination, USG abdomen and X ray abdomen. All the patients were assessed preoperatively, intra-operatively and post-operatively, and the findings were recorded in a pre-structured proforma. Patients were evaluated in terms of age, gender, and Body Mass Index (BMI), mean operation time, length of hospital stay, pre-operative investigations, surgical technique, and post-operative complications.

Results: 56 cases affected with IH were males accounting to 54.9% cases. 46 cases out of 101 were females making about 45.1% of cases of IH. Male preponderance i.e. Male: Female ratio being 1.2:1 was seen in the study (Table 1). The most common cause of IH was post-operative wound infection (47%). The other causes were obesity (19%), improper rest (12%), COPD (16%), BHP (6%) etc. Some of the cases had got multiple etiological factors, but main causes are depicted in the chart.

Conclusion: Prevention of IH is to be taken care of, by avoiding infection during index operation with thorough peritoneal toileting, proper surgical techniques and appropriate antibiotics. Although laparoscopic mesh repair needs more operating time and skill, it has lesser blood loss, hospital stay and recurrence rate when compared to other procedures.