ABSTRACT
Background: In our tertiary care hospital, we receive a large number of acute abdomen cases. Raised intra-abdominal pressure (IAP) makes laparostomy mandatory initially and abdominal wall approximation cannot be completed due to compromised state in most cases. Large incisional hernias were seen on complete healing and this study was done to see the feasibility of component separation technique (CST) with mesh augmentation.Methods: 30 patients were subjected to CST with mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring of IAP were done. Pain scoring by visual analogue scale (VAS), early and late complications was noted. Patients were followed up for 60 months.Results: CST with mesh augmentation was found to be feasible with 96.77% success rate as no recurrence was noted in follow up. Preoperative average Basal metabolic index was 26.09. Size of defect varied from 17-20×9-16 cm2 (length X width). Seroma seen in 50% of patients was managed without any intervention. Skin necrosis in 6.6% and wound dehiscence in 3.33%, managed with minimal debridement & local wound care respectively. Respiratory compromise and hematoma were not seen and no patient required any active ICU care. Average length of hospital stay was 5.22 days. Close monitoring of IAP in immediate post-operative period was found to be significant.Conclusion: Physical acceptance of stable abdominal wall gives a psychological boost to patients with early recovery in form of ambulation and early return to work.
ABSTRACT
Aims: A ventral hernia is a protrusion of viscera through an abdominal wall defect. Ventral hernias are mostly treated by a surgical procedure called open ventral hernia repair (OVHR). However, complications arising from the OVHR procedure mayresult in the recurrence of a hernia.This study was aimed to measure the recurrence rate of ventral hernia after OVHR with mesh and the reasons for failure.Study Design:It was a cross-sectional retrospective study conducted on all patients who underwent an OVHR with mesh, between 2010 and 2017, at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Data were extracted from KAUH medical records. A total of 241 patients were included in the study, divided into two groups; group 1-patients with recurrence(37 patients) and group 2-patients with no recurrence(204 patients).Consent was taken from patientsand preoperative assessment of procedures were performed under general anesthesia. The variables in the study are parameters like age, sex, parity, and history of chronic liver disease and their correlation with recurrence of thehernia. Different variables Data were analyzed by SPSS v 21. Association between the variables was determined using the t-test and Pearson’s Chi-squared tests.Results:The relationship between recurrence and age was statistically significant (P=0.019). The recurrence of hernia was more frequent in females than males. Patients with a history of multiparity(P=0.00) and liver diseases (P=0.041) showed significant differences in terms of recurrence. The umbilical hernia was more prevalent (133 cases; 55.2%) than other types of hernia. The most frequent site of hernia in the recurrence group was supraumbilical(38.46%; P=0.039).Conclusion:OVHR is a commonly performed surgical procedure at KAUH. Because of multiparity, ventral hernia recurrence was more common in women than men. To reduce recurrences, we recommend doing exercises to strengthen the abdominal muscles. Patients with chronic liver diseases in the form of portal hypertension should avoid surgical repair. For the surgeons, the type of mesh does not have a significant impact on recurrence