A comparative study of various techniques of incisional hernia repair in a tertiary care center at Bikaner (North-West Rajasthan)
Keywords:Incisional hernia, Anatomical repair, Mesh repair
Background: Incisional hernia can be defined as an internal abdominal wall defect that develops after a previously closed laparotomy. Aim of present study was to compare open suture repair and mesh repair (onlay and sublay), various factors predisposing to incisional hernia and evaluate complications following surgery for incisional hernias.
Methods: A prospective study was conducted in 60 cases of incisional hernia admitted in Department of General Surgery, PBM Hospital Bikaner between October 2017 to September 2018. 20 cases were selected in each group (open anatomical repair, onlay mesh repair and sublay mesh repair). All cases were followed up for 6 months postoperatively.
Results: Incisional hernia was found to occur more often in 41-60 years age group (61.67%) and in females. Wound infection (46.67%) after index surgery was most important risk factor followed by obesity. LSCS (30%) was found to be most common index surgery followed by hysterectomy (28.33%). Seroma was most common postoperative complication (5% patient in anatomical repair group, 30% patients in onlay group and 10% patients in sublay group).Only one recurrence (5%) was observed in anatomical repair group over a period of 6 months follow up.
Conclusions: Sublay mesh repair is superior to onlay mesh repair and Anatomical suture repair regarding recurrence rate. Local postoperative complications like seroma formation or wound infection were more common in mesh repair surgery than anatomical repair. Among mesh repair these complications were higher in onlay group than sublay repair.
Mudge M, Hughes LE, Incisional Hernias: A10 years prospective study of incidence and attitudes. BR J Surg. 1985;72:70-1.
Langer S, Christian J. Long term results after incisional hernia repair. Acta Chir Scand. 1985;151(3):217-9.
Abrahamson J. Hernias. In: Zinner MJ, Schwartz SI, Ellis H, eds. Maingot’s Abdominal Operations. 10th edition. York: Appleton & Lange; 1997: 479 – 580.
Read RC, Yoder G. Recent trends in the management of incisional herniation. Arch Surg. 1989;124:485-8.
Yahchouchy-Chouillard E, Aura T, Picone O, Etienne J-C, Fingerhut A.Incisional hernias. I. Related risk factors. Dig Surg. 2003;20(1):3-9.
Lamont PM, Ellis H. Incisional hernia in re-opened abdominal incisions: an overlooked risk factor. Br J Surg. 1988;75(4):374-6.
Manninen MJ, Lavonius M, Perhoniemi VJ Results of incisonal hernia repair. A retrospective study of 172 unselected hernioplasties. Eur J Surg 1991;157:29-31
Pollak R, Nyhus LM. Incisional Hernias. In: Schwartz SI, Ellis H, eds. Maingots Abdominal Operations. 8th ed. V 1. Norwalk, Connecti cut: Appleton-Century-Crofts, 1985: 335-50
Akman PC. A study of five hundred incisional hernias. F Int Coll Surg 1962;37: 125-42
Andrew N, Kingsnorth, Lablanc KA. Management of abdominal Hernia, 3rd edition. New York. Arnold publishers, 2003.
Fischer JD, Turner FW. Abdominal incisional hernia:A ten year review;Can J. Surgery:171,202-204
Pollock AV, Greenall MJ, Evans M. Single-layer mass closure of major laparotomies by continuous suturing. J R Soc Med 1979;72:889-893.
Ellis H, Coleridge-Smith PD, Joyce AD. Abdominal incisions-vertical or transeverse? Postgrad Med J 1984;60:407-410.
Bhattarai A, Bhandari RS. Incisional Hernia Repair. Journal of Institute of Medicine, April, 2010; 32(1): 34-37
Ellis H, Gajraj H, George CD. Incisional hernias: when do they occur? Br J Surg. 1983 May;70(5):290–291.
Jehad M. Odeh. Mesh versus suture repair for primary midline incisional hernia- experience at Royal medical services hospitals. JRMS August 2009; 16(2): 31-34
Dhaigude BD, Sugunan A, Panchbhai SV, Francis M, Patel K, Metta V. Comparative evaluation of sublay versus onlay meshplasty in incisional and ventral hernias. Int Surg J 2018;5:187-92.
Garg N, Batra P, Bali S. The clinical study of the incisional hernia and its management. Int Surg J 2017;4:2281-7.
Bose SM, Lal Roshan, Kalra Manju, Wig JD, Khanna SK. Ventral hernia-a review of 175 cases. Indian J Surg. 1999;61(3):180-84.
Nanjappa N, Mohanty A, Smile R. Incisional hernia repair – a clinical study of 30 patients. Int j Cur Res Rev. 2013;5(15):35-41.
Shivakumar T, Pavan BM, Narendra MC, Arava S, Babu NS, Mahadev NH. Comparison of Open Mesh Repair with Open Suture Repair of Incisional Hernia. Int J Sci Stud. 2016;4(2):84-89.
Tulaskar N, Nichkaode P, Dasgupta S, Gurjar G, Umalkar R. Clinical study and management of incisional hernia by onlay or preperitoneal mesh repair: A Prospective study in rural set up. IJBAR. 2013;4(5):329-34.
Omer AN. Comparison between Onlay and Inlay mesh in repair of incisional hernia. Al-azhar Assiut Medcail J. 2014;12(3):362-76.
Shah JB. Incisional hernia-a study of 50 cases. Indian J Surg. 1977;39:353-6.
Goel TC, Dubey PC. Abdominal incisional hernia- Anatomical technique of repair. Indian J Surg. 1981;43:324-7.
Hameed F, Ahmed B, Ahmed A, Dab RH, Dilawaiz. Incisional Hernia Repair by Preperitoneal (Sublay) Mesh Implantation. A.P.M.C 2009;3(1):27-31.
Deshmukh SN, Varudkar AS, Chopde AV. Clinical study and management of incisional hernias: a prospective monocenter experience. Int Surg J 2017;4:1657-61.
Baracs J, Sajjadi GS, Kelemen D, Horvath OP, Vereczkei A, Vereczkei A, et al. Open Treatment of Abdominal Wall Hernias: Mesh Repair is Superior to Suture Repair and Onlay Mesh is Better than Sublay Mesh – Five-Year Multicentric, Prospective, Randomised Clinical Trial. Surg Curr Res. 2016;6:1-7.
Lamani YP, Halbhavi SN, Goudar BV, Kalaburgi EB, Gowd VYC. Open mesh repair, is still a standard technique for incisional hernia: a comparision study between sublay and onlay technique in the era of laparoscopy. Int Surg J. 2018;5:834-7.
Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Annals of Surgery. 2004;240(4):578.
Kharde K, Dogra BB, Panchabhai S, Rana KV, Sridharan S, Kalyan S. A comparative study of onlay and retrorectus mesh placement in incisional hernia repair. Med J DY Patil Univ. 2013;6:258-62.