Factors affecting the development of ventral incisional hernia post abdominal surgery: a retrospective cohort study

Ankur Sidhu; Declan Siedler; Richard Turner

doi:10.18203/2349-2902.isj20174199

Authors

Ankur Sidhu Department of Surgery, Royal Hobart Hospital, Tasmania, Australia
Declan Siedler School of Medicine, Faculty of Health, University of Tasmania, Australia
Richard Turner Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20174199

Keywords:

Incisional hernia, Risk factors, Ventral incisional hernia

Abstract

Background: Ventral incisional hernia (VIH) is one of the most common post-operative complications following abdominal surgery. The objective of this study was to evaluate the rate and risk factors associated with development of a ventral incisional hernia (VIH).

Methods: Patients who underwent major abdominal surgery between 2010 and 2012 at a single institution were included in this retrospective cohort study. Data were collected from medical records. The primary outcome was clinical or radiological evidence of incisional hernia; explanatory variables were patient demographics and potential clinico-pathological risk factors for hernia development.

Results: A total of 295 patients who underwent laparotomy were analysed. 45 (15.25%) patients were found to have a ventral incisional hernia on follow-up. The median time to development of hernia was 351 days. There were equal numbers of elective (N=22) and emergency (N=23) operations that developed an incisional hernia. Of the explanatory variables considered diabetes, hypertension (HTN) and body mass index (BMI) had persistent significant positive associations with the development of an incisional hernia. On univariable analysis diabetes (HR = 2.73, p-value = 0.004) and hypertension (HR =2.17, p-value = 0.016) were identified as independent risk factors for hernia development. BMI was also significantly associated with development of an incisional hernia on univariate analysis, but due to missing data this did not reach statistical significance on multivariable analysis.

Conclusions: Although there are several risk factors to development of VIH, diabetes and HTN were associated with development of incisional hernia in our study. BMI also appears to be an important determinant of development of VIH. Further research in this area is likely to identify an at-risk subset of patients, who may benefit from weight loss prior to surgery or prophylactic mesh post-laparotomy.

Metrics

Metrics Loading ...

References

Burger JW, Lange JF, Halm JA, Kleinrensink GJ, Jeekel H. Incisional hernia: early complication of abdominal surgery. World J Surg. 2005;29:1608-13.

Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed). 1982;284:931-3.

Yahchouchy-Chouillard E, Aura T, Picone O, Etienne JC, Fingerhut A. Incisional hernias. 1. Related risk factors. Dig Surg. 2003;20:3-9.

Sørensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jørgensen LN. Smoking is a risk factor for incisional hernia. Arch Surg. 2005;140:119-23.

Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, et al. Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg. 2014;101:1439-1447.

Mudge M, Hughes LE. Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg. 1985;72(1):70-1.

Richards PC, Balch CM, Aldrete JS. Abdominal wound closure. A randomised prospective study of 571 patients comparing continuous vs interrupted suture techniques. Ann Surg. 1983;197(2):238-43.

Sadava EE, Cabo JK, Carballo FHE, Bun ME, Rotholtz NA. Incisional hernia after laparoscopic colorectal surgery. Is there any factor associated? Surgical Endoscopy. 2014;28:3421-4.

Bhaskaran A, Ambikavathy M. Incisional hernia: A review of etiopathogenesis, clinical presentation, complications and management. J Clin Biomed Sci. 2013;3(1).

Goodenough CJ, Ko TC, Kao LS, Nguyen MT, Holihan JL, Alawadi Z, et al. Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery. Hernia expectation rates in intra-abdominal surgery (The HERNIA Project). J Am Coll Surg. 2015;220(4)405-13.