Clinical application value of abdominal incisional hernia repair

Abstract

Objective To investigate the clinical application value of abdominal incisional hernia repair. Methods The retrospective and descriptive study was conducted. The clinical data of 104 patients who underwent abdominal incisional hernia repair in the Wuhan No.1 Hospital from January 2013 to December 2017 were collected. There were 38 males and 66 females, aged (58±4)years, with a range from 31 to 85 years. All patients underwent abdominal incisional hernia repair by patch implantation. Observation indicators: (1) intraoperative conditions; (2) complications; (3) follow-up. Follow-up by telephone questionnaires was performed to detect the postoperative recurrence up to June 2019. Measurement data with normal distribution were expressed as Mean±SD, measurement data with skewed distribution were expressed as M (P25, P75), and count data were expressed as absolute numbers. Results (1) Intraoperative conditions: all the 104 patients underwent the abdominal incisional hernia repair successfully. The operation time, duration of postoperative hospital stay were (111±18)minutes and (6.1±2.4)days. Among the 104 patients, 29 underwent open surgery, 38 underwent laparoscopic surgery, and 37 underwent hybrid surgery. Among the 29 patients undergoing open surgery, 25 had defect area in the subumbilical region (M4 type), 2 had defect area in the hypochondrial region (L2 type), and 2 had defect area in the ilium region (L3 type); all patients had patches placed in posterior muscle space. Among the 38 patients undergoing laparoscopic surgery, 9 had subxiphoid defects (M1 type), 23 had epigastric defects (M2 type), and 6 had subcostal defects (L1 type); all patients had patches placed in intraperitoneal cavity. Among the 37 patients undergoing hybrid surgery, 27 had umbilical defects (M3 type) and 10 had suprapubic defects (M5 type); all patients had patches placed in intraperitoneal cavity. (2) Complications: among the 29 patients undergoing open surgery, 7 had complications, including 4 of pain in the repaired area of abdominal wall, 1 of poor wound healing, and 2 of seroma in the repaired area. Among the 38 patients undergoing laparoscopic surgery, 2 were suffered from pain in the repaired area of abdominal wall. Among the 37 patients undergoing hybrid surgery, 6 had complications, including 2 of poor wound healing and 4 of seroma in the repair area. Among the 104 patients, 6 patients with pain in the repair area of abdominal wall after operation were improved by local closure and analgesic treatment; 3 patients of poor wound healing were healed well after local dressing change and secondary debridement and suture; 6 patients with seroma in the repaired area were cured by puncture, drainage and pressure bandage. No intestinal fistula, intestinal obstruction, abdominal compartment syndrome or death occurred. (3)Follow-up: 104 patients were followed up for 13 months (3 months, 24 months). Among the 104 patients, 1 recurred at 6 months, 13 months and 16 months after operation, respectively. All the 3 patients were recovered and discharged after re-repair. Conclusion Abdominal incisional hernia repair is safe and effective, which should be selected according to the specific conditions of the operation. Key words: Hernia; Abdominal incisional hernia; Repair surgery; Opening; Hybridization; Clinical application; Laparoscopy