3- OUTCOME OF LARGE INCISIONAL HERNIA REPAIR WITH POLYPROPYLENE MESH

Abstract

Incision hernia remains a frequent complication of abdominal surgeries with a reported incidence of (2-20%). Repair of large incision hernia is a difficult surgical problem with short and long term complications, severity of these complications are related in part to the type of operative technique adopted. The aim of this study is to evaluate the outcome of repair of large incision hernia with the (onlay tension free) mesh technique. This is a retrospective study includes 46 patients who underwent mesh repair for large incision hernia during the period from January 1997 to December 2004. The operations were done by the same surgeon and by the same procedure (i.e; onlay tension free polypropylene mesh with two points fixation). Data regarding relevant patients with big ventral incision hernia with (onlaymesh repair) in Basrah teaching hospital and private hospital were revised. The presenting condition, hernia description, associated systemic and local factors, procedure of repair and follow up duration were all taken in consideration. Possible complications like; hematoma, seroma, wound infection, intestinal obstruction and enterocutaneous fistula were recorded and discussed once they occurred. The follow up period ranged from 4 to 21 months. Forty six patients were included in the study: 20 females and 26 males with median age of 50.5 year (range 35-68 year). Eleven patients (23.91%) were overweight and had body mass index "BMI" equal to more than 30, four patients (8.69%) had controlled diabetes mellitus, five (10.86%) had controlled hypertension and two (4.34%) suffered from chronic obstructive air way disease, there were eleven smokers (23.91%). Sixteen patients made regular visits that extended up to 12 months, 12 patients made regular visits up to 6 months, one made regular visits up to 18 month mainly due to partial intestinal obstruction., one patient was followed-up to 17 month because of multiple wound sinuses while 8 patients made irregular visits up to 21 month due to causes other than the hernia, eight patients lost from follow-up after 4 months. The original operation was bowel related in 18 cases, gynecological in twelve, hepatopancreatobiliary in 10, repair of paraumbalical hernia in six patients. The old incisions were long midline in 23 cases, paramedian in 17 and transverse in six patients. The main postoperative complications were seroma formation (13.04 %), wound haematoma (6.52 %), wound infection (4.34 %). no recurrence of hernia and no enterocutanous fistula were reported during our follow-up period. In conclusion, tension free onlay mesh repair is a feasible operative procedure for repair of large incision hernia with no significant major morbidity.

Keywords

• incisional hernia repair
• polypropylene mesh