A Comprehensive study on Incidence and Management of Incisional Hernias

Subha Lakshmi, N (2013) A Comprehensive study on Incidence and Management of Incisional Hernias. Masters thesis, K.A.P. Viswanatham Government Medical College, Tiruchirappalli.


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INTRODUCTION: Incisional hernia is the hernia that appears between the layers of the abdominal wall that develops in the scar of the surgical incision. Incisional Hernias make up about 80% of ventral hernias that surgeons encounter. The range of incisional hernias rates after laprotomy is from 2% to 11% which means that at least 150000 patients are going to develop this complication from abdominal surgery. Once incisional hernia occurs, the natural history is for it to grow. Delay in repair complicates every single aspect of the surgery and leads to increase morbidity. So repair should be done as soon as possible as. As it grows the chances of complications such as in cacerations and strangulation of viscera, atrophy of subcuteanous tissue, thinning of skin, ulceration of skin and loss of domain of the viscera occurs. The lateral abdominal muscles retract and become fibrotic and this enlarges the defect. All these things greatly complicate any repair and increase the chance of repair failure and prosthetic infection and wound problems. If the patient is obese weight loss makes the surgery easier. Closure is much easier with much lower recurrence rate. Excess skin and fat can be excised which pleases the patient. AIM OF STUDY: 1. To identify the etiology, predisposing factors and contributing factors for the ventral incisional hernia. 2. To find the incidence of incisional hernia following various abdominal incisions. 3. Management of ventral incisional hernia. MATERIALS AND METHODS: This prospective study was conducted in Mahatma Gandhi Memorial Hospital, Trichy for the period of 2010 - 2012. Study of 50 cases of incisional hernia has been carried out under the guidance of Prof.Dr.A.Kanagasundaram MS my chief in Mahatma Gandhi Memorial Govt. Hospital, Trichy. Patients were considered eligible if they had an incisional hernia defined as the palpable fascia or muscle defect at the site of the previous abdominal incision. Hernias were detected clinically and assessed by ultrasonography. Certain aspects like obesity, anemia, diabetes, chronic bronchitis, hypertension and chronic constipation were particularly looked for. Clinical observation and statistical analysis follow up, results of mesh repair were measured. The college ethics committee approved the study protocol. Routine laboratory investigations like urine, blood, chest screening, electrocardiogram were done. OBSERVATIONS AND DISCUSSIONS: In our study 50 cases were studied over a period of 2 years. High incidence of incisional hernias is seen in females when compared to males .Since lower segment caesarean section is the most commonly done surgery in females. Most of the incisional hernias is seen in middle age around 30 – 50 years since these people was subjected to more surgeries and more amount of stress like lifting heavy weight and also due to collagen disorders Since most of the incisional hernias occur through LSCS scar and the incision is below the umbilicus and the defiency of the posterior rectus sheath predisposes to this and also more common among emergency procedures Wound infection in the post operative period is the most common complication met in repair of incisional hernia since the seroma is the cause for the same due to excessive handling of subcutaneous tissue . occurrence of the incisional hernia is seen in the first three years of previous surgery since the lack of adequate rest is the reason for this occurrence 22 patients presented with swelling and 13 patients presented with pain in our study . Most of the repair done in our hospital are onlay mesh repair since the rate of recurrence is less after mesh repair when compared to anatomical repair. CONCLUSION: Careful analysis of the current surgical literature including four recently published meta analyses indicates that a consistent conclusion can be made regarding an optimal technique. The abdominal closure technique should be fast, easy and cost effective while preventing both early and late complications. The technique involves mass closure incorporating all the layers of abdominal wall (except skin) as one structure in a simple running technique using 1-0 or 2-0 absorbable monofilament suture material with a suture length to wound length ratio of 4:1. Use of mesh has drastically reduced the rate of recurrence of incisional hernia. Mesh repair is the gold standard for the treatment of incisional hernias. We should all remember that incisional hernia is a preventable surgical complication.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Incisional Hernias ; Incidence ; Management ; Comprehensive study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 03 May 2018 04:37
Last Modified: 03 May 2018 12:15
URI: http://repository-tnmgrmu.ac.in/id/eprint/7411

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