Incisional Hernia: lisk factors, prevention, and repair

Incisional hernia is a major health care problem. It is one of the most frequent longterm complications of abdominal surgery and it continues to be a significant problem for patients as well as surgeons. As a result of advances in surgical knowledge and increase in the variety and number of abdominal incisions, the incidence of postoperative incisional hernias has increased rapidly. Unfortunately, attempts of repair of these hernias have not been uneventful, with high rates of hernia recurrence, and considerable rates of morbidity and mortality, making many surgeons hesitant to undertake incisional hernia repair. On the other hand, however, delay in repair may have serious clinical consequences. Apart from discomfort and pain, incisional hernias may predispose to incarceration or strangulation of primarily small bowel, which is almost certainly fatal if not promptly reduced. Also, as a consequence of the impact on health, incisional hernias have enormous economic consequences. At this time no consensus has been reached about whether, how, and when to operate on a patient with an incisiona

Incisional hernia recurrence following 'vest-over-pants' or vertical mayo repair of primary hernias of the midline

A series of 68 primary midline incisional hernias with a vertical Mayo repair was evaluated retrospectively. Patients without documented hernia recurrence following this repair were invited for physical examination. Life- table methods were used for statistical analysis. The 1-, 3-, 5-, and 10- year cumulative recurrence rates were 35%, 46%, 48%, and 54%, respectively. Also, generally accepted risk factors were studied. Multivariate analysis identified the size of the hernia (p = 0.02) and the use of steroids (p = 0.04) as the most important independent risk factors of first time recurrent incisional hernia. Considering the high recurrence rates found, the results of this study strongly suggest that the vest-over-pants repair should no longer be used for closure of midline incisional hernias

The low transverse Pfannenstiel incision and the prevalence of incisional hernia and nerve entrapment

Objective: The authors determined the prevalence of incisional hernia and nerve entrapment in patients with a low transverse Pfannenstiel incision. Summary Background Data: The literature on the Pfannenstiel incision suggests an incisional hernia rate of 0.0% to 0.5%. However, in these series, physical examination, which is essential in the authors' view, was not performed. To the authors' knowledge, the prevalence of nerve entrapment after the Pfannenstiel incision is not known or has never been published. Methods: All adult women, operated on between 1986 and 1992 using a Pfannenstiel incision and not having had another lower abdominal incision other than for laparoscopy, were invited for follow-up at the outpatient department. All patients were interviewed and subjected to a physical examination, with special interest to the presence of incisional hernia or nerve entrapment. Results: In patients having had a Pfannenstiel incision, no incisional hernias were found. In patients also having had a laparoscopy, the incisional hernia rate was 3.5%. Nerve entrapment was found in 3.7%. The length of the incision was ide