Incisional hernias: why do they occur?

Over a period of five years 110 cases of incisional hernia were evaluated at teaching hospitals of Dow Medical College and Peoples Medical College, Nawabshah to ascertain their causes. It was found that these hernias were seen more frequently after emergency surgery [87.27%] performed by resident surgeons [89.09%]. About 70% patients had previous history of gynaecological and obstetric operations. Midline incision is more prone to herniation than paramedic and transverse incisions as evidenced by 73.64% patients in this series. Other important causative factors are wound infection [69.09%], chest infection [30.91%], abdominal distension [14.55%] and constipation

Comparative study of repair of incisional hernia

Repair of incisional hernias was compared with four different techniques in 55 patients to determine the best method of repair with least chance of recurrence. The maximum incidence of incisional hernia was seen in 30-39 years age group and was most frequently seen after gynaecological surgery [37 cases]. Forty eight [88%] patients were operated in emergency by trainee surgeons. Most hernias occurred within one year after surgery and the herniation of lower mid line incision was more frequent [70.9% cases]. History of wound infection of previous surgery was recorded in 45.5% of cases which appeared to be the important risk factor in causation of incisional hernia. It was also observed that simple repair of incisional hernia was associated with a high recurrence than that where synthetic mesh was used in repair where no recurrence was recorded

Comparative study of repair of incisional hernia

In this study fifty five patients were operated for the repair of incisional hernias with four different techniques to compare the results and to find out the best possible method of repair with least incidence of recurrence. As the recurrence of the incisional hernia occurs in high percentage of cases causes disappointment to both patient and Surgeon. The maximum incidence of incisional hernia was seen in 40-63 years age group. Incisional hernias were seen more frequently after gynaecological surgery in 37 [67.2%] cases and 18 [32.7%] cases reported after General Surgery Operation. Forty eight [88%] patients presented with incisional hernias were operated in emergency by trainee surgeons. Most hernias occurred within one year after surgery and the herniation of lower mid line incision was more frequent in 70.9% of cases. History of wound infection of previous surgery recorded is 45.5% of cases which is the important risk factor in causation of incisional hernia. In view of literature it is reported that the results are satisfactory with the use of synthetic prosthesis to strengthen the repair in comparison to simple technique. We have also observed after comparing the results of different techniques that simple repair of incisional hernia has significant rate of recurrence where as when synthetic mesh was used in repair no recurrence was recorded