Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients

Abstract EN

Background / Aim : the incisional hernia is one of the major elements of morbidity after abdominal surgery.

In the best centers the incidence of post-operative hernia has been at least 10 percent as shown by long follow up.

The risk of developing an incisional hernia can be increased due to patients' related factors as age, obesity, D.M, cirrhosis, cough, constipation, smoking, glucocorticoid therapy, multiparty, malignancy and previous abdominal operations.

It was soon recognized that vertical midline incisions were the most common site of postoperative incisional herniation because of this awareness, more consideration was given to choice of incisions wound closure, and wound healing to protect against incisional hernia.

The aim of this work is to reduce the incidence of incisional hernia in high-risk patients after midline abdominal incision by prophylactic prosthetic reinforcement.

Patients and methods : From October 2002 to September 2003, Forty (40) high-risk patients liable to develop postoperative incisional hernia underwent elective abdominal operations through midline incisions were operated upon at Gastroenterology and laparoscopic Unit, Surgery Department, Tanta University Hospital They were randomly divided into two groups ; Group A : patients for whom the midline abdominal incisions were closed by conventional method and reinforced by subfascial polypropylene mesh, (20 patients).

Group B : patients for whom the midline abdominal incisions were closed by conventional method only (20 patients).

With follow up period up to3.5 years.

RESULTS : this study included 40 patients (18 males and 22 females) divided in to two groups (A, B) with most patients around age of 50-60 years (12 patients, 5 in group A and 7 in group B).

In this study, twenty-three patients (57.5 %) were presented with more than one risk factor (9 in group A and 14 in group B).

Types of midline abdominal incisions done in this study, upper midline incisions in 19 patients (11 in group A and 8 in group B), extended upper midline in incisionsl4 patients (6 in groups A and 8 in groups B), lower midline incisions in 7 patients.

(3 in group A and 4 in group B) Early local postoperative complications, subcutaneous sarcoma in 7 patients (2 in group A and 4 in group B), surgical site infection.

(1 in group A and 2 in group B), partial wound disruption.

(4 in group A and 3 in group B) and complete wound disruption.

(Complete burst) in only one patients in group B.

Late postoperative complications chronic wound pain Three patients (15 %) in group A, ascites three patients in (group A) and one in (group B) all were cirrhotic patients, developed moderate postoperative ascites.

None of (group A) patients developed postoperative incisional hernia during follow up, while three patients 15 % in (group B) developed postoperativejncisional hernia.

Conclusion : prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients can be used safely and effectively to provide an extrinsic strength of the wound without relying much on the defective development of its own intrinsic strength and to prevent subsequent incisional hernia.

The final statement should await the outcomes of the long term follow up of the studied cases.