FACTORS INFLUENCING POST-OPERATIVE COMPLICATIONS AFTER PROSTHETIC "MESH" REPAIR OF INCISIONAL HERNIA (A prospective study)

Abstract

Incisional hernia is frequently met by the general surgeon, its frequently complicate (3.8-11.5%) of patients after abdominal surgery. Repair of large incisional hernia is a difficult surgical problem with recurrence being a common. Numerous methods of repair have been described simple opposition in one layer or complex opposition and the use of prosthetic mesh. The aim of this study is to report our experience with use of mesh repair and risk factors that influence post operative complications. A prospective study done in Basrah General Hospital, Department of Surgery between January 2003 to December 2006.One hundred and ten patients with prosthetic repair of incisional hernia were included in this study. History was taken and thorough examination was done, all patients were asked for history of diabetes mellitus, obesity, corticosteroid use, their original operations, primary or recurrent hernia and examined for their body mass index, size and duration of the hernial defect were recorded. A proforma was completed for each patient, noting prophylactic antibiotics had been given or not, type of the sac and whether opened or inverted, type and size of mesh had been used, intraoperative and postoperative complications and postoperative hospital stay. Of (110) patients, (62) were females, (48)were males,their median age was (45.5) years for women and (58) years for men,(31)patients(28.2%)weighted more than their ideal body weight and had body mass index equal or more than(30).Forty eight patients (43.6%) were diabetic and (24)patients(21.8%)were corticosteroid used. The original operations were bowel related and gynecological in the majority of patients. Previous incisions were long midline in(38). Twenty patients had one past operation, (13)had two,(5) had three and one patient had four past repair, the remaining were new Incisional hernia patients. The main hernia size was (12.3) cm and (4.6) cm in vertical and horizontal direction respectively. Forty four patients had additional surgical procedures, consisted of Fallopian tube ligation in (12) ,division of small bowel adhesions in (8) ,suturing of small bowel perforation in (4) and abdominoplasty in (20) patients. In the majority of patients (78), standard polypropylene mesh had been used and vicryl-prolene (Vypro) mesh in the remaining (32) patients. The main postoperative complications were seroma formation (17.3%), wound haematoma (10%), wound infection (9.1%), chest infection (6.4%), one patient developed intestinal fistula and mesh need to be removed. Five recurrent incisional hernias occurred. Most patients developed complications were obese, diabetic and corticosteroid used. No death in our series. It is concluded that tension free incisional hernia repair using prosthetic mesh is a safe and easy procedure with no major morbidity or recurrence. The patient-doctor should advice weight loss to help reduce risks of surgery and improve the surgical results. Control of diabetes, corticosteroid drug use and smoking cessation are recommended for better results. Rigid sterile condition, precise and meticulous technique with the use of closed suction drains is important.