Incisional Hernia Post Laparotomy-Incidence and Risk Factors

Abstract

Laparotomy incisions are one of the most common procedures performed in any surgical service. However, they carry certain risks like surgical site infections, wound dehiscence and incisional hernia. There have been various risk factors associated with the incidence of incisional hernia post laparotomy. Some of these factors are patients-related like history of diabetes, obesity, smoking, sex and age. The other factors are related to the disease process itself like emergency surgeries, presence of peritonitis, history of radiation to the abdominal cavity or presence of surgical site infection. Another set of factors relates purely with the technique used to close the wound, choice of suture material and expertise of the surgeon. Methods. This is a retrospective chart review. Data was collected from all patients who were previously admitted at Hamad General Hospital for laparotomy and subsequently developed incisional hernia. Methods. All patients of age 18 years or above who were found to have incisional hernia after laparotomy were included in the study. Hospital medical records database were used for file reviews. Patients characteristics like age, sex, obesity, history of smoking, DM etc were recorded. Nature of surgeries like emergency or elective were documented along with other factors like suturing techniques etc. Results. The total number of study subjects was 672, out of which 47 (6.9%) developed incisional hernia. Out of these 23 were male and 24 were female. Diabetes was identified in 18 patients (38.3%) whereas the incidence of smoking, steroid use, COPD and obesity was 2 (4.3%), 0 (%), 3 (6.4%) and 7 (14.9%) respectively. Other risk factors like the nature of surgery (emergency vs electives) were addressed also. The incidence of immediate postop complications was also addressed. Three patients out of 47 (6.4%) developed surgical site infection whereas one patient (2.1%) had post-op wound dehiscence. The number of contaminated and dirty wounds during the initial surgery was 10 (21.3%) and 6 (12.8%) respectively.

Is the incision type important for the development of hernia in liver transplant patients?

“…It was thought that the stronger muscle structures of male patients compared to female patients and their exposure to more physical pain in the early postoperative period may play a role. It is known that bleeding and wound infection increase the development of IH after laparotomy which is performed for other reasons 20,21 . As a result of their meta‐analysis, Bulter et al.…”

“…It is known that bleeding and wound infection increase the development of IH after laparotomy which is performed for other reasons. 20,21 As a result of their meta-analysis, Bulter et al reported that among the patients who underwent LT, the risk of developing IH in patients with postoperative bleeding and wound infection during the follow-up increased. 22 According to the our results, we seen that male gender (p = .021), high BMI rate (p = .003), postoperative bleeding (p = .018), and wound infection (p = .039) as a risk factor on development of IH.…”

Transversus Abdominis Release (TAR) Procedure: Experience of An Abdominal Wall Reconstruction Group.

“…Throughout time, complex abdominal wall defects have increased due to patients' possibility to overcome critical illness after laparotomy [15], presenting a new surgical challenge that requires a wide armamentarium of surgical techniques and approaches, seeking to provide a proper reconstruction, procedure, showing positive results, with less proportion of recurrence (< 4% in 12 months), postoperative complications (hematoma (<1%), seroma (<3%), surgical site infection (SSI) (<10%)) and an acceptable median length of hospitalization of 5.9 days [4,16].…”