The role of surgical access in postoperative ventral hernia development

Kuznetsov N.A.; Schastlivtsev I.V.; Tsaplin S.N.

doi:https://doi.org/

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Abstract:

Long-term follow-up of 508 patients after various surgical procedures has been conducted. Of the 351 patients were operated on using a paramedian incision, 109 had an upper median laparotomy and the rest 48 had an oblique subcostal incision. Posopertaive ventral hernias were registered in 45 (8.86%) patients. The upper median laparotomy herniated in 18 (16.51%) patients, paramedian incision - in 17 (4.84%), and the oblique subcostal incision herniated in 10 (20.83%). Hernia was noticed by the patient within 12 months after the initial operation in 46.67%, of them in 85.71% - within first 6 months. 53,33% of patients were diagnosed with postoperative hernia only after thorough examination. Thus, paramedian incision is considered to be the most preferrable access. Postoperative hernias develop within the first 6-12 months postoperatively, later hernia registration is a result of poor examination.

Keywords:

postoperative ventral hernia

surgical treatment

incision

Authors:

Kuznetsov N.A.

Kafedra obshcheĭ khirurgii lechebnogo fakul'teta GOU VPO RGMU Roszdrava, Moskva

Schastlivtsev I.V.

Department of General Surgery and Radiodiagnostics, State budgetary educational institution of higher professional education «N.I. Pirogov Russian National Research Medical University»;
Clinical Hospital No 1 (Volynskaya), General Management Department of the Presidential Administration

ORCID: 0000-0002-1306-1502

Tsaplin S.N.

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References:

Belokonev V.I., Fedorina T.A., Kovaleva Z.V. i dr. Patogenez i khirurgicheskoe lechenie posleoperatsionnykh ventral'nykh gryzh. Samara: Perspektiva seriya "Trudnye voprosy khirurgii" 2005; 208.
Gogiya B.Sh. Khirurgicheskoe lechenie posleoperatsionnykh ventral'nykh gryzh: Avtoref. dis. ... d-ra med. nauk. M 2006; 387.
Egiev V.N. Nenatyazhnaya gernioplastika. M: Medpraktika-M 2002; 148.
Zhebrovskii V.V. Khirurgiya gryzh zhivota. M: Meditsinskoe informatsionnoe agentstvo 2005; 384.
Pautkin Yu.F., Klimov A.E. Khirurgiya zhelchnykh putei: Rukovodstvo dlya vrachei. M: Meditsinskoe informatsionnoe agentstvo 2007; 368.
Savel'ev B.C. Rukovodstvo po neotlozhnoi khirurgii organov bryushnoi polosti. M: Triada-Kh 2004; 640.
Timoshin A.D., Yurasov A.V., Shestakov A.L. Khirurgicheskoe lechenie pakhovykh i posleoperatsionnykh gryzh bryushnoi stenki. M: Triada-Kh 2003; 144.
Andersen L.P., Klein M., Gögenur I., Rosenberg J. Incisional hernia after open versus laparoscopic sigmoid resection. Surg Endosc 2008; 22: 9: 2026-2029.
Anthony T., Bergen P.C., Kim L.T. et al. Factors affecting recurrence following incisional herniorrhaphy. World J Surg 2000; 24: 1: 95-101.
Ausobsky J.R., Evans M., Pollock A.V. Does mass closure of midline laparotomies stand the test of time? A random control clinical trial. Ann R Coll Surg Engl 1985; 67: 159-161.
Baker R.J. Incisional hernia. In: L.M. Nyhus, R.E. Condon eds. Hernia. Philadelphia: Lippincott 1978; 329-341.
Brolin R.E. Prospective, randomized evaluation of midline fascial closure in gastric bariatric operations. Am J Surg 1996; 172: 4: 328-331.
Bucknall T.E. Factors influencing wound complications: a clinical and experimental study. Ann R Coll Surg Engl 1983; 65: 2: 71-77.
Bucknall T.E., Cox P.J., Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. BMJ 1982; 284: 931-933.
Burger J.W., Luijendijk R.W., Hop W.C. et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004; 240: 4: 578-583; discussion 583-585.
Cengiz Y., Israelsson L.A. Closure of midline incisions. A lot of small, same-size stitches in the aponeurosis improve wound healing. Lakartidningen 2002; 99: 24: 2742-2744.
Cengiz Y., Israelsson L.A. Incisional hernias in midline incisions: An eight-year follow up. Hernia 1998; 2: 4: 175-177.
Chevrel J.P., Rath A.M. Classification of incisional hernias of abdominal wall. Hernia 2000; 4: 1: 7-11.
Cobb W.S., Kercher K.W., Heniford B.T. The Argument for Lightweight Polypropylene Mesh in Hernia Repair. SURG. INNOV 2005; 12: 63-69.
den Hartog D., Dur A.H., Kamphuis A.G. et al. Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias. Hernia 2009; 13: 1: 45-48.
Doherty G.M. Current diagnosis and treatment: Surgery, Thirteenth edition. Mc Graw-Hill Medical. USA 2010; 1312.
Donaldson D.R., Hall T.J., Zoltowski J.A. et al. Does the type of suture material contribute to the strength of the lateral paramedian incision? Br J Surg 1982; 69: 3: 163-165.
Donaldson D.R., Hegarty J.H., Brennan T.G. et al. The lateral paramedian incision-experience with 850 cases. Br J Surg 1982; 69: 10: 630-632.
Dubay D.A., Wang X., Kuhn M.A. et al. The prevention of incisional hernia formation using a delayed-release polymer of basic fibroblast growth factor. Ann Surg 2004; 240: 1: 179-186.
Dur A.H., den Hartog D., Tuinebreijer W.E. et al. Low recurrence rate of a two-layered closure repair for primary and recurrent midline incisional hernia without mesh. Hernia 2009; 13: 4: 421-426.
Ellis H., Gajraj H., George C.D. Incisional hernias: when do they occur? Br J Surg 1983; 70: 290-291.
Flum D.R., Harvath K., Koepsell T. Have outcomes of incisional hernia repair improved with time? - a population-based analysis. Ann Surg 2003; 237: 129-135.
Franz M.G., Smith P.D., Wachtel T.L. et al. Fascial incisions heal faster then skin: a new model of abdominal wall repair. Surgery 2001; 129: 2: 203-208.
Ghahremani G.G., Jimenez M.A., Rosenfeld M., Rochester D. CT diagnosis of occult incisional hernias. Am J Roentgenol 1987; 148: 1: 139-142.
Gilbert J.M., Ellis H., Foweraker S. Peritoneal closure after lateral paramedian incision. Br J Surg 1987; 74: 113-115.
Gislason H., Gronbech J.E., Soreide O. Burst abdomen and incisional hernia after major gastrointestinal operations - comparison of three closure techniques. Eur J Surg 1995; 161: 349-354.
Gys T., Hubens A. A prospective comparative clinical study between monofilament absorbable and non-absorbable sutures for abdominal wall closure. Acta Chir Belg 1989; 89: 265-270.
Halm J.A., Lip H., Schmitz P.I., Jeekel J. Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision. Hernia 2009; 13: 3: 275-280.
Harding K.G., Mudge M., Leinster S.J. et al. Late development of incisional hernias: An unrecognised problem. Br Med J 1983; 286: 519-520.
Hesselink V.J., Luijendijk R.W., de Wilt J.H.W. et al. An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 1993; 176: 228-234.
Hoer J., Lawong G., Klinge U., Schumpelick V. Einflussfaktoren der Narbenhernienentstehung Retrospektive Untersuchung an 2.983 laparotomierten Patienten über einen Zeitraum von 10 Jahren. Der Chirurg 2002; 73: 474-480.
Hoer J., Stumpf M., Rosch R. et al. Prophylaxe der Narbenhernie. Der Chirurg 2002; 73: 881-887.
Hsiao W.C., Young K.C., Wang S.T., Lin P.W. Incisional hernia after laparotomy: prospective randomized comparison between early-absorbable and late-absorbable suture materials. World J Surg 2000; 24: 6: 747-751.
Israelsson L.A., Jonsson T. Incisional hernia after midline laparotomy: a prospective study. Eur J Surg 1996; 162: 2: 125-129.
Israelsson L.A., Jonsson T. Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg 1997; 163: 3: 175-180.
Israelsson L.A., Jonsson T., Knutsson A. Suture technique and wound healing in midline laparotomy incisions. Eur J Surg 1996; 162: 8: 605-609.
Itani K.M., Hur K., Kim L.T. et al. Veterans Affairs Ventral Incisional Hernia Investigators. Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg 2010; 145: 4: 322-328.
Kahn J., Müller H., Iberer F. et al. Incisional hernia following liver transplantation: incidence and predisposing factors. Clin Transplant 2007; 21: 3: 423-426.
Kendall S.W.H., Brennan T.G., Gillou P.J. Suture length to wound length ratio and integrity of midline and paramedian incisions. Br J Surg 1991; 78: 705-707.
Klinge U., Prescher A., Klosterhalfen B. et al. Entstehung und Pathophysiologic der Bauchwanddefekte. Der Chirurg 1997; 68: 293-303.
Knaebel H.P., Koch M., Sauerland S. et al. INSECT Study Group of the Study Centre of the German Surgical Society: Interrupted or continuous slowly absorbable sutures - design of a multi-centre randomised trial to evaluate abdominal closure techniques INSECT-trial. BMC Surg 2005; 5: 3.
Korenkov M., Sauerland S., Arndt M. et al. Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia. Br J Surg 2002; 89: 50-56.
Langer C., Schaper A., Liersch T. et al. Prognosis factors in incisional hernia surgery: 25 years of experience. Hernia 2005; 9: 1: 16-21.
Llaguna O.H., Avgerinos D.V., Lugo J.Z. et al. Incidence and risk factors for the development of incisional hernia following elective laparoscopic versus open colon resections. Am J Surg 2010; 199: 2: 263-265.
Lord R.S., Crozier J.A., Snell J., Meek A.C. Transverse abdominal incisions compared with midline incisions for elective infrarenal aortic reconstruction: predisposition to incisional hernia in patients with increased intraoperative blood loss. J Vasc Surg 1994; 20: 1: 27-33.
Luijendijk R.W., Hop W.C., van den Tol M.P. et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2000; 343: 6: 392-398.
Millbourn D., Cengiz Y., Israelsson L.A. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 2009; 144: 11: 1056-1059.
Mohebali K., Young D.M., Hansen S.L. et al. Open incisional hernia repair at an academic tertiary care medical center. Arch Surg 2009; 144: 9: 848-852.
Moussavian M.R., Schuld J., Dauer D. et al. Long term follow up for incisional hernia after severe secondary peritonitis-incidence and risk factors. Am J Surg 2010; 199: 4: 582-583.
Mudge M., Hughes L.E. Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 1985; 72: 1: 70-71.
O'Dwyer P.J., Courtney S.A. Factors involved in abdominal wall closure and subsequent incisional hernia. Surgeon 2003; 1: 1: 17-22.
Playforth M.J., Sauven P.D., Evans M. et al. The prediction of incisional hernias by radio-opaque markers. Ann R Coll Surg Engl 1986; 68: 82-84.
Pollock A.V., Evans M. Early prediction of late incisional hernias. Br J Surg 1989; 76: 953-954.
Rahbari N.N., Knebel P., Diener M.K. et al. Current practice of abdominal wall closure in elective surgery - Is there any consensus? BMC Surg 2009; 9: 8.
Regnard J.F., Hay J.M., Rea S. et al. Ventral incisional hernias: incidence, date of recurrence, localization and risk factors. Ital J Surg Sci 1988; 18: 3: 259-265.
Rodriguez H.E., Matsumura J.S., Morasch M.D. et al. Abdominal wall hernias after open abdominal aortic aneurysm repair: prospective radiographic detection and clinical implications. Vass Endovasc Surg 2004; 38: 237-240.
Santora T.A., Roslyn J.J. Incisional hernia. Surg Clin North Am 1993; 73: 557-570.
Sorensen L.T., Hemmingsen U.B., Kirkeby L.T. et al. Smoking is a risk factor for incisional hernia. Arch Surg 2005; 140: 2: 119-123.
Stoppa R.E. The treatment of complicated groin and incisional hernias. World J Surg 1989; 13: 5: 545-554.
Togo S., Nagano Y., Masumoto C. et al. Outcome of and risk factors for incisional hernia after partial hepatectomy. J Gastrointest Surg 2008; 12: 6: 1115-1120.
Wolter A., Rudroff C., Sauerland S., Heiss M.M. Laparoscopic incisional hernia repair: evaluation of effectiveness and experiences. Hernia 2009; 13: 5: 469-474.