Study of Post-Tubectomy Incisional Hernia

Abstract

Introduction: The mini laparotomy or Pomeroy technique is considered as revolutionary procedure for female sterilisation. It is also found to be suitable procedure at the primary health centre level and in mass campaigns. It was author’s observation that the patients operated for the tubectomy in camps arranged by government in rural areas often presents with complaints of incisional hernia. Aim: To analyse the causes for the incisional hernia operated by mini laparotomy technique and to study different methods of surgical treatment for the post tubectomy incisional hernia. Materials and Methods: Patients history of previous surgery, time since previous surgery, demographic characteristics, intraoperative findings, co-morbidities, postoperative hospital stay, postoperative complications and type of repair were recorded. Primary anatomical repair was done for defects less than 4 cm with non-absorbable polypropylene suture in intermittent manner. Each suture separated by 0.6-0.7 cm. defects more than 4 cm were repaired with meshplasty. Results: Most of patients were between 20-30 years age. There was no evidence of any remnant of suture material in all patient who underwent surgery for incisional hernia, it was concluded that these patients underwent repair of mini laparotomy with absorbable suture material. There were no complications in 32 patients with anatomical repair, three patients had wound infection but healed completely after regular cleaning and dressing. Two patients developed seroma which was drained by removal of a suture and subsequently healed without complication. Meshplasty done for defects >4 cm. Average hospital stay for anatomical non-absorbable suture repair was 2.91 days and that for meshplasty was 5.2 days. Patients were followed up for two years and no recurrence seen. Conclusion: Use of absorbable suture material for closure of abdomen can lead to incisional hernia even if the size of the incision is small. Primary anatomical repair with non absorbable intermittent sutures is sufficient for infraumbilical midline incisional hernia of size less than 4 cm.

Keywords

• absorbable suture
• anatomical repair
• meshplasty