Incisional Hernia Post Laparotomy-Incidence and Risk Factors

Amjad Shah; Zia Aftab; Syed Muhammad Ali; Salah Gehani; Khalid Ahmed; Ahmed Almodaris; Rashad Fouad; Abdulrahman Al-Aal

doi:doi:10.11648/j.js.20180601.14

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Incisional Hernia Post Laparotomy-Incidence and Risk Factors

Amjad Shah, Zia Aftab, Syed Muhammad Ali, Salah Gehani, Khalid Ahmed, Ahmed Almodaris, Rashad Fouad, Abdulrahman Al-Aal

Published in Journal of Surgery (Volume 6, Issue 1)

Received: 27 November 2017 Accepted: 8 December 2017 Published: 16 January 2018

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Abstract

Laparotomy incisions are one of the most common procedures performed in any surgical service. However, they carry certain risks like surgical site infections, wound dehiscence and incisional hernia. There have been various risk factors associated with the incidence of incisional hernia post laparotomy. Some of these factors are patients- related like history of diabetes, obesity, smoking, sex and age. The other factors are related to the disease process itself like emergency surgeries, presence of peritonitis, history of radiation to the abdominal cavity or presence of surgical site infection. Another set of factors relates purely with the technique used to close the wound, choice of suture material and expertise of the surgeon. Methods. This is a retrospective chart review. Data was collected from all patients who were previously admitted at Hamad General Hospital for laparotomy and subsequently developed incisional hernia. Methods. All patients of age 18 years or above who were found to have incisional hernia after laparotomy were included in the study. Hospital medical records database were used for file reviews. Patients characteristics like age, sex, obesity, history of smoking, DM etc were recorded. Nature of surgeries like emergency or elective were documented along with other factors like suturing techniques etc. Results. The total number of study subjects was 672, out of which 47 (6.9%) developed incisional hernia. Out of these 23 were male and 24 were female. Diabetes was identified in 18 patients (38.3%) whereas the incidence of smoking, steroid use, COPD and obesity was 2 (4.3%), 0 (%), 3 (6.4%) and 7 (14.9%) respectively. Other risk factors like the nature of surgery (emergency vs electives) were addressed also. The incidence of immediate postop complications was also addressed. Three patients out of 47 (6.4%) developed surgical site infection whereas one patient (2.1%) had post -op wound dehiscence. The number of contaminated and dirty wounds during the initial surgery was 10 (21.3%) and 6 (12.8%) respectively.

Published in	Journal of Surgery (Volume 6, Issue 1)
DOI	10.11648/j.js.20180601.14
Page(s)	19-22
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Laparotomy, Incisional Hernia, Risk Factors, Incidence

References

[1]	Incisional hernia after open resections for colorectal liver Metastases – incidence and risk factors Jan H. Nilsson, Peter Strandberg Holka & Christian Sturesson HPB (Oxford). 2016 May; 18 (5): 436–441.
[2]	Millbourn D, Cengiz Y, Israelsson LA: Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 2009, 144 (11): 1056-1059.
[3]	Israelsson LA, Jonsson T: Overweight and healing of midline incisions: the importance of suture technique Eur J Surg 1997, 163 (3): 175-180e.
[4]	Sugerman HJ, Kellum JM, Reines HD, DeMaria EJ, Newsome HH, Lowry JW: Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 1996, 171 (1): 80-84.
[5]	Israelsson LA, Jonsson T: Incisional hernia after midline laparotomy: a prospective study. Eur J Surg 1996, 162 (2): 125-129.
[6]	C. Fink P. Baumann, M. N. Wente, P. Knebel, T. Bruckner, A. Ulrich, J. WernerM. W. Bu¨ chler and M. K. Diener. Incisional hernia rate 3 years after midline laparotomy Published online 26 November 2013 in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.9364.
[7]	Ismat M Mutwali, Incisional Hernia: Risk Factors, Incidence, Pathogenesis, Prevention and Complications. Sch. J. App. Med. Sci., 2014; 2 (4E): 1491-1497.
[8]	Dunja Kokotovic, MB; Thue Bisgaard, MD, DMSc; Frederik Helgstrand, MD, DMSc. Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair. JAMA. 2016; 316 (15): 1575-1582. doi:10.1001/jama.2016.15217.
[9]	René H Forteln Y, Petra Baumann, Wolfgang E Thasler, Markus Albertsmeier, Stefan Riedl, Wolfgang Steurer, Jan Ludolf Kewer and Andreas Shamiyeh. Effect of suture technique on the occurrence of incisional hernia after elective midline abdominal wall closure: study protocol for a randomized controlled trial. Trials 201516: 52.https://doi.org/10.1186/s13063-015-0572-x.
[10]	Abd-El-Aal A. Saleem, Hassan A. Abdallah, Osama A. Abdul Raheem, Mohamed A. Yousef. Rate of development of incisional hernia 1 year after urgent midline laparotomy. Al Azhar Assiut Medical Journal 2016, 14: 59–66.
[11]	Timothy F. Feldmann, MD, Monica T. Young, MD, and Alessio Pigazzi, MD, PhD. Incisional Reinforcement in High-Risk Patients. Clin Colon Rectal Surg. 2014 December; 27 (4): 149–155.
[12]	Fischer JP, Basta MN, Mirzabeigi MN, Bauder AR, Fox JP, Drebin JA, Serletti JM, Kovach SJ. A Risk Model and Cost Analysis of Incisional Hernia After Elective, Abdominal Surgery Based Upon 12,373 Cases: The Case for Targeted Prophylactic Intervention. Ann Surg.

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APA Style

Amjad Shah, Zia Aftab, Syed Muhammad Ali, Salah Gehani, Khalid Ahmed, et al. (2018). Incisional Hernia Post Laparotomy-Incidence and Risk Factors. Journal of Surgery, 6(1), 19-22. https://doi.org/10.11648/j.js.20180601.14

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ACS Style

Amjad Shah; Zia Aftab; Syed Muhammad Ali; Salah Gehani; Khalid Ahmed, et al. Incisional Hernia Post Laparotomy-Incidence and Risk Factors. J. Surg. 2018, 6(1), 19-22. doi: 10.11648/j.js.20180601.14

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AMA Style

Amjad Shah, Zia Aftab, Syed Muhammad Ali, Salah Gehani, Khalid Ahmed, et al. Incisional Hernia Post Laparotomy-Incidence and Risk Factors. J Surg. 2018;6(1):19-22. doi: 10.11648/j.js.20180601.14

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@article{10.11648/j.js.20180601.14,
  author = {Amjad Shah and Zia Aftab and Syed Muhammad Ali and Salah Gehani and Khalid Ahmed and Ahmed Almodaris and Rashad Fouad and Abdulrahman Al-Aal},
  title = {Incisional Hernia Post Laparotomy-Incidence and Risk Factors},
  journal = {Journal of Surgery},
  volume = {6},
  number = {1},
  pages = {19-22},
  doi = {10.11648/j.js.20180601.14},
  url = {https://doi.org/10.11648/j.js.20180601.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20180601.14},
  abstract = {Laparotomy incisions are one of the most common procedures performed in any surgical service. However, they carry certain risks like surgical site infections, wound dehiscence and incisional hernia. There have been various risk factors associated with the incidence of incisional hernia post laparotomy. Some of these factors are patients- related like history of diabetes, obesity, smoking, sex and age. The other factors are related to the disease process itself like emergency surgeries, presence of peritonitis, history of radiation to the abdominal cavity or presence of surgical site infection. Another set of factors relates purely with the technique used to close the wound, choice of suture material and expertise of the surgeon. Methods. This is a retrospective chart review. Data was collected from all patients who were previously admitted at Hamad General Hospital for laparotomy and subsequently developed incisional hernia. Methods. All patients of age 18 years or above who were found to have incisional hernia after laparotomy were included in the study. Hospital medical records database were used for file reviews. Patients characteristics like age, sex, obesity, history of smoking, DM etc were recorded. Nature of surgeries like emergency or elective were documented along with other factors like suturing techniques etc. Results. The total number of study subjects was 672, out of which 47 (6.9%) developed incisional hernia. Out of these 23 were male and 24 were female. Diabetes was identified in 18 patients (38.3%) whereas the incidence of smoking, steroid use, COPD and obesity was 2 (4.3%), 0 (%), 3 (6.4%) and 7 (14.9%) respectively. Other risk factors like the nature of surgery (emergency vs electives) were addressed also. The incidence of immediate postop complications was also addressed. Three patients out of 47 (6.4%) developed surgical site infection whereas one patient (2.1%) had post -op wound dehiscence. The number of contaminated and dirty wounds during the initial surgery was 10 (21.3%) and 6 (12.8%) respectively.},
 year = {2018}
}

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TY - JOUR
T1 - Incisional Hernia Post Laparotomy-Incidence and Risk Factors
AU - Amjad Shah
AU - Zia Aftab
AU - Syed Muhammad Ali
AU - Salah Gehani
AU - Khalid Ahmed
AU - Ahmed Almodaris
AU - Rashad Fouad
AU - Abdulrahman Al-Aal
Y1 - 2018/01/16
PY - 2018
N1 - https://doi.org/10.11648/j.js.20180601.14
DO - 10.11648/j.js.20180601.14
T2 - Journal of Surgery
JF - Journal of Surgery
JO - Journal of Surgery
SP - 19
EP - 22
PB - Science Publishing Group
SN - 2330-0930
UR - https://doi.org/10.11648/j.js.20180601.14
AB - Laparotomy incisions are one of the most common procedures performed in any surgical service. However, they carry certain risks like surgical site infections, wound dehiscence and incisional hernia. There have been various risk factors associated with the incidence of incisional hernia post laparotomy. Some of these factors are patients- related like history of diabetes, obesity, smoking, sex and age. The other factors are related to the disease process itself like emergency surgeries, presence of peritonitis, history of radiation to the abdominal cavity or presence of surgical site infection. Another set of factors relates purely with the technique used to close the wound, choice of suture material and expertise of the surgeon. Methods. This is a retrospective chart review. Data was collected from all patients who were previously admitted at Hamad General Hospital for laparotomy and subsequently developed incisional hernia. Methods. All patients of age 18 years or above who were found to have incisional hernia after laparotomy were included in the study. Hospital medical records database were used for file reviews. Patients characteristics like age, sex, obesity, history of smoking, DM etc were recorded. Nature of surgeries like emergency or elective were documented along with other factors like suturing techniques etc. Results. The total number of study subjects was 672, out of which 47 (6.9%) developed incisional hernia. Out of these 23 were male and 24 were female. Diabetes was identified in 18 patients (38.3%) whereas the incidence of smoking, steroid use, COPD and obesity was 2 (4.3%), 0 (%), 3 (6.4%) and 7 (14.9%) respectively. Other risk factors like the nature of surgery (emergency vs electives) were addressed also. The incidence of immediate postop complications was also addressed. Three patients out of 47 (6.4%) developed surgical site infection whereas one patient (2.1%) had post -op wound dehiscence. The number of contaminated and dirty wounds during the initial surgery was 10 (21.3%) and 6 (12.8%) respectively.
VL - 6
IS - 1
ER -

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Author Information

Amjad Shah

General Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
Zia Aftab

General Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
Syed Muhammad Ali

General Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
Salah Gehani

General Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
Khalid Ahmed

Trauma and Critical Care, Hamad General Hospital, Doha, Qatar
Ahmed Almodaris

General Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
Rashad Fouad

General Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
Abdulrahman Al-Aal

General Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar

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APA Style

Amjad Shah, Zia Aftab, Syed Muhammad Ali, Salah Gehani, Khalid Ahmed, et al. (2018). Incisional Hernia Post Laparotomy-Incidence and Risk Factors. Journal of Surgery, 6(1), 19-22. https://doi.org/10.11648/j.js.20180601.14

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ACS Style

Amjad Shah; Zia Aftab; Syed Muhammad Ali; Salah Gehani; Khalid Ahmed, et al. Incisional Hernia Post Laparotomy-Incidence and Risk Factors. J. Surg. 2018, 6(1), 19-22. doi: 10.11648/j.js.20180601.14

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AMA Style

Amjad Shah, Zia Aftab, Syed Muhammad Ali, Salah Gehani, Khalid Ahmed, et al. Incisional Hernia Post Laparotomy-Incidence and Risk Factors. J Surg. 2018;6(1):19-22. doi: 10.11648/j.js.20180601.14

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@article{10.11648/j.js.20180601.14,
  author = {Amjad Shah and Zia Aftab and Syed Muhammad Ali and Salah Gehani and Khalid Ahmed and Ahmed Almodaris and Rashad Fouad and Abdulrahman Al-Aal},
  title = {Incisional Hernia Post Laparotomy-Incidence and Risk Factors},
  journal = {Journal of Surgery},
  volume = {6},
  number = {1},
  pages = {19-22},
  doi = {10.11648/j.js.20180601.14},
  url = {https://doi.org/10.11648/j.js.20180601.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20180601.14},
  abstract = {Laparotomy incisions are one of the most common procedures performed in any surgical service. However, they carry certain risks like surgical site infections, wound dehiscence and incisional hernia. There have been various risk factors associated with the incidence of incisional hernia post laparotomy. Some of these factors are patients- related like history of diabetes, obesity, smoking, sex and age. The other factors are related to the disease process itself like emergency surgeries, presence of peritonitis, history of radiation to the abdominal cavity or presence of surgical site infection. Another set of factors relates purely with the technique used to close the wound, choice of suture material and expertise of the surgeon. Methods. This is a retrospective chart review. Data was collected from all patients who were previously admitted at Hamad General Hospital for laparotomy and subsequently developed incisional hernia. Methods. All patients of age 18 years or above who were found to have incisional hernia after laparotomy were included in the study. Hospital medical records database were used for file reviews. Patients characteristics like age, sex, obesity, history of smoking, DM etc were recorded. Nature of surgeries like emergency or elective were documented along with other factors like suturing techniques etc. Results. The total number of study subjects was 672, out of which 47 (6.9%) developed incisional hernia. Out of these 23 were male and 24 were female. Diabetes was identified in 18 patients (38.3%) whereas the incidence of smoking, steroid use, COPD and obesity was 2 (4.3%), 0 (%), 3 (6.4%) and 7 (14.9%) respectively. Other risk factors like the nature of surgery (emergency vs electives) were addressed also. The incidence of immediate postop complications was also addressed. Three patients out of 47 (6.4%) developed surgical site infection whereas one patient (2.1%) had post -op wound dehiscence. The number of contaminated and dirty wounds during the initial surgery was 10 (21.3%) and 6 (12.8%) respectively.},
 year = {2018}
}

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