A comparative study of various techniques of incisional hernia repair in a tertiary care center at Bikaner (North-West Rajasthan)

Abstract

Background: Incisional hernia can be defined as an internal abdominal wall defect that develops after a previously closed laparotomy. Aim of present study was to compare open suture repair and mesh repair (onlay and sublay), various factors predisposing to incisional hernia and evaluate complications following surgery for incisional hernias.Methods: A prospective study was conducted in 60 cases of incisional hernia admitted in Department of General Surgery, PBM Hospital Bikaner between October 2017 to September 2018. 20 cases were selected in each group (open anatomical repair, onlay mesh repair and sublay mesh repair). All cases were followed up for 6 months postoperatively.Results: Incisional hernia was found to occur more often in 41-60 years age group (61.67%) and in females. Wound infection (46.67%) after index surgery was most important risk factor followed by obesity. LSCS (30%) was found to be most common index surgery followed by hysterectomy (28.33%). Seroma was most common postoperative complication (5% patient in anatomical repair group, 30% patients in onlay group and 10% patients in sublay group).Only one recurrence (5%) was observed in anatomical repair group over a period of 6 months follow up.Conclusions: Sublay mesh repair is superior to onlay mesh repair and Anatomical suture repair regarding recurrence rate. Local postoperative complications like seroma formation or wound infection were more common in mesh repair surgery than anatomical repair. Among mesh repair these complications were higher in onlay group than sublay repair.

Comparative Study between Sublay versus Onlay Mesh Repair in Treatment of Incisional Hernia

“…In the present study, 73.3% of the cases developed incisional hernia through a midline incision. This coincides with the results of Singh et al who found that midline incision was the original incision upon which the hernia developed in 85% of the cases [10] . Ahmed and Mehboob reported that in 64.6% of their cases, incisional hernia developed on top of a midline incision [6] .…”

“…This shows a slight increase in the incidence of incisional hernia in the female gender. The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also increased incidence of obesity in females [10] . This is similar to the results obtained by Kurzer et al, in their study of the long term results of sublay mesh repair of incisional hernia in 125 patients.…”

“…In their study on 60 cases of incisional hernia, Kapoor and Hassan reported that in 87% of the cases, the original operation was done on an emergency basis due to peritonitis or intestinal obstruction [12] . Singh et al, found that the most common risk factor for development of incisional hernia was the occurrence of wound infection after the previous surgery that was found in 46.67% of their cases [10] . Similar to our study, Garg et al, found that obesity, smoking, chronic cough, diabetes mellitus and anemia were important risk factors for incisional hernia development [13] .…”

A Comparative study in elective repair of large incisional hernias using on- lay mesh vs. sub-lay mesh- A Meta-analysis

“…The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also increased incidence of obesity in females . 2 The most common risk factor for development of incisional hernia was the occurrence of wound infection after the previous surgery that was found in 46.67% of their cases. Also obesity, smoking, chronic cough, diabetes mellitus and anemia were important risk factors for incisional hernia development .…”