Incisional Hernia Case Study

RATE OF DEVELOPMENT OF INCISIONAL HERNIA ONE YEAR AFTER URGENT MIDLINE LAPAROTOMY

Abd-El-Aal A. Saleem1, Hassan A. Abdallah1, Osama A. Abdul

Raheem1, Mohamed Yousef A1.

1 Department of General Surgery, Faculty of Medicine, Aswan University, Aswan, Egypt.

Correspondence to Abd-El-Aal A. Saleem, MD, Department of General

Surgery, Faculty of Medicine, Aswan University, Aswan, Egypt.

Tel.: [phone] e-mail:[e-mail] ABSTRACT

OBJECTIVE

To determine the rate of development of incisional hernia six months and one year follow up in patients suffering from peritonitis ( potentially septic wounds) and other patients suffering

The cumulative incidence has remained constant despite several attempts to improve laparotomy closure. As well as surgical closure technique, individual biological and patient dependent risk factors play a key role.1 Incisional hernia remain the most frequent long-term complications in visceral surgery after midline laparotomy, often requiring reoperation for repairing. The rate one year after laparotomy is within the range of 9 - 20 percent.2 The rate of incisional hernia increased significantly from 12.6% at one year to 22.4% at 3 years after midline laparotomy.3 The cause of incisional hernia is multifactorial and influenced by patient related and technical factors. Patient-related factors include obesity, malignancy, wound infection, diabetes mellitus, use of immunosuppressant agents, corticosteroids, smoking and previous laparotomy and cannot be influenced by the surgeon. Technical factors, however, are directly controllable and amenable to action by the surgeon. Attempts to minimize hernia rates after laparotomy have led to various surgical options ;variations of incision type, closure technique and suture material.3 There is high incidence of incisional hernia following operations for peritonitis because, as a rule , the wound becomes infected. The placing of a drainage tube through a separate stab incision as opposed to bringing such a tube through the laparotomy wound

In a period from 1st June 2014 to 30 January 2015.The number of cases were one hundred and sixty (160) patients underwent urgent exploratory laparotomy and analysis of their records. Data were collected by us and our residents in emergency departments of Aswan University Hospital. The consent was taken from patients or their guardians and relatives. Those patients were divided into two groups ( A & B ). Group A (80 patients) were suffering from peritonitis due to e.g perforated peptic ulcer, perforated appendix….etc, so they were considered as potentially septic wounds, also group A was divided into two subgroups (A1& A2). Subgroup A1 (40 patients) in which the midline laparotomy incision was closed by continuous suture technique plus some interrupted sutures in between using vicryl (Polyglactin) suture material (multifilamentous- slowly absorbable material). Subgroup A2 (40 patients) in which the midline laparotomy incision was closed by continuous suture technique with no interrupted sutures in between using prolene (Polypropylene) suture material ( monofilamentous-non absorbable material). Group B (80 patients) were suffering from intra-peritoneal hemorrhage (IPHge) due to e.g splenic tear, liver tear….etc. , so they were considered as a septic wounds, also group B was divided into