ABSTRACT BACKGROUND:

Incisional hernia is a common complication of abdominal surgery and an important source of morbidity. A wide spectrum of surgical techniques has been developed ranging from suturing techniques to the use of various types of prosthetic mesh repair. Use of preperitoneal mesh repair technique showed reduced number of postoperative complications and recurrence compared to other techniques.

OBJECTIVES:

• To study the role of Preperitoneal mesh repair in incisional hernia.
• To study the postoperative complications in this procedure.

METHODS :

Prospective clinical study consisting of 50 patients with incisional hernia managed by preperitoneal mesh repair in Kempegowda Institute Medical Sciences and Research Centre, Bangalore during the period from October 2003 to December 2005.

RESULTS:

• Less number of postoperative complications noticed in the present
• The duration of hospital stay is increased when risk factors are present.
• No recurrence notice in the present
• Comparing with other techniques of mesh repair (in literature), the preperitoneal mesh repair has got less postoperative complications and

INTERPRETATION AND CONCLUSION

• Preperitoneal mesh repair had excellent long-term results, with minimal
• In preperitoneal mesh repair, less number of postoperative complications noticed and with no recurrence.
• Comparing with other techniques (in literature) it is a gold standard treatment for incisional repair.

KEYWORDS

Incisional hernia, Mesh repair, Preperitoneal mesh repair, Postoperative complications; Recurrence.

INTRODUCTION :

Ian Aird defines incisional hernia as a diffuse extrusion of peritoneum and abdominal contents through a weak scar after a operation or accidental wound (1). The exact incidence at incisional herniae has not been well defined, although a number of reports in the literature suggest that the incidence is probably between 2% and 11%. Recent studies however show that about 2/3 appear within the first 5 years and that at least another third appear 5-10 years after the operation. It is seen more in females, obese, older age group. Jack Abrahmson a pioneer in hernia surgery in the modern era said, many factors singly or in various combinations may cause failure of the wound to heal satisfactorily and lead to development of Incisional hernia , main causes in its causation are Poor surgical technique and Sepsis. Hernias were considered large, when the width measured more than 10 cm at its greatest diameter. Medium hernias measured between 6 and 10 cms in diameter.  Small hernias were those under 6 cm. Complications of hernia include irreducibility is frequent and partial obstruction, Strangulation, Spontaneous ulceration, rupture. Considering the significant recurrence rate noted after various techniques for incisional hernia repair, the task of repairing this defect can challenge the scientific and artistic talents of the most experienced surgeon. Various types of repair have been described, both anatomical and prosthetic. But the results have been disappointing with a high incidence of recurrence-about upto 50% after an anatomical repair and upto 10% following prosthetic mesh repairs (2). In general the postoperative complications of incisional hernia include pulmonary atelactasis, bronchitis, pulmonary embolism. postoperative ileus, thrombophlebitis and deep venous thrombosis, where as local complications like wound seroma, haematoma, infection, sinuses and complications of mesh.

Mesh repair is an excellent method of repair preferred for patients with large defects of the anterior abdominal wall, especially preferred more than 4 cm, size defect (3,4,5). An excellent method, which has been used, called Rive’s Stoppa technique, where mesh was placed between peritoneum and abdominal wall or rectus muscle and posterior rectus sheath (6). The main advantage of pre peritoneal mesh repair are – Less chance of mesh infection and erosion through skin because the graft lies in preperitoneal plane between posterior rectus sheath and peritoneum, avoids adhesions, bowel obstruction, enterocutaneous fistula and erosion of mesh, minimal morbidity and duration of hospital stay is less compared to other techniques. The main disadvantage is more time consuming, extensive preparation of preperitoneal plane and surgical experience.

The present our study aims at management of incisional hernia by preperitoneal mesh repair in our surgical department.