Clinical Evaluation of Incisional Hernia

Chang, Donghan; Yang, Heeyoung; Son, Shin; Park, Kyunghwan

Abstract

An incisional hernia is still one of the common complications of abdominal surgical procedures and is a significant source of morbidity. The exact incidence of incisional hernias has not been well defined, although a number of reports in the literature suggest that it is between 2% and 11%. Repair of incisional hernias is a common procedure from the surgeon's viewpoint. The authors evaluated the clinical data of 34 patients with incisional hernias at the Department of Surgery, Daedong Hospital, Busan, between January 1990 and December 1996. Incisional hernias were more common in females(9 men and 25 women), and the range of ages was 29 to 79. The incidence was highest in lower midline incisions. Some factors supposed to be associated with the development of incisional hernias were a lower midline incision, increased abdominal pressure, wound infection, reincision, and previous incisional hernia. Severe vomiting, abdominal distension, severe coughing, obesity, and pregnancy contributed to the increased abdominal pressure. An appendectomy was the most common preceding operation for the occurrence of an incisional hernia, although the incidence of appendectomies at the author's hospital was the highest of all other operations. The most frequent symptom or sign of the patients was mass or bulging at the previous operation site. Herniation occurred in 18 patients (52.9%) within 1 year after the preceding operation and herniorrhaphies were performed in 14 cases (41.2%) within 1 year after herniation. The size of hernia in 32 patients (94.1%) was less than 10 cm in diameter, and mesh was used in four patients (11.8%). The method of repair was determined by the size of the defect and by the tension around the defect. Postoperative follow up was made by telephone in 20 of the 34 patients. Among them, the authors were notified of two recurrent incisional hernias: One developed after an operation for mechanical obstruction due to an appendectomy. The other recurred at the lower midline incision for an operation due to rupture of the small bowel and was accompanied by wound infection.