7- FACTORS INFLUENCING POST-OPERATIVE COMPLICATIONS AFTER PROSTHETIC "MESH" REPAIR OF INCISIONAL HERNIA (A prospective study).

Abstract

Incisional hernia is frequently met by the general surgeon, its frequently complicate (3.8-11.5%)of patients after abdominal surgery. Repair of large incisional hernia is a difficult surgicalproblem with recurrence being a common. Numerous methods of repair have been describedsimple opposition in one layer or complex opposition and the use of prosthetic mesh.The aim of this study is to report our experience with use of mesh repair and risk factors thatinfluence post operative complications.A prospective study done in Basrah General Hospital, Department of Surgery between January2003 to December 2006.One hundred and ten patients with prosthetic repair of incisional herniawere included in this study. History was taken and thorough examination was done, all patientswere asked for history of diabetes mellitus, obesity, corticosteroid use, their original operations,primary or recurrent hernia and examined for their body mass index, size and duration of thehernial defect were recorded. A proforma was completed for each patient, noting prophylacticantibiotics had been given or not, type of the sac and whether opened or inverted, type and sizeof mesh had been used, intraoperative and postoperative complications and postoperativehospital stay.Of (110) patients, (62) were females, (48)were males,their median age was (45.5) years forwomen and (58) years for men,(31)patients(28.2%)weighted more than their ideal body weightand had body mass index equal or more than(30).Forty eight patients (43.6%) were diabeticand (24)patients(21.8%)were corticosteroid used. The original operations were bowel relatedand gynecological in the majority of patients. Previous incisions were long midline in(38).Twenty patients had one past operation, (13)had two,(5) had three and one patient had fourpast repair, the remaining were new Incisional hernia patients. The main hernia size was (12.3)cm and (4.6) cm in vertical and horizontal direction respectively. Forty four patients hadadditional surgical procedures, consisted of Fallopian tube ligation in (12) ,division of smallbowel adhesions in (8) ,suturing of small bowel perforation in (4) and abdominoplasty in (20)patients. In the majority of patients (78), standard polypropylene mesh had been used andvicryl-prolene (Vypro) mesh in the remaining (32) patients. The main postoperativecomplications were seroma formation (17.3%), wound haematoma (10%), wound infection(9.1%), chest infection (6.4%), one patient developed intestinal fistula and mesh need to beremoved. Five recurrent incisional hernias occurred. Most patients developed complicationswere obese, diabetic and corticosteroid used. No death in our series.It is concluded that tension free incisional hernia repair using prosthetic mesh is a safe andeasy procedure with no major morbidity or recurrence. The patient-doctor should advice weightloss to help reduce risks of surgery and improve the surgical results. Control of diabetes,corticosteroid drug use and smoking cessation are recommended for better results. Rigid sterilecondition, precise and meticulous technique with the use of closed suction drains is important.

Keywords

PROSTHETIC