Page 130 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 6
Abstract
Background
Incisional hernia (IH) is the most frequent complication after abdominal surgery with an incidence of 11-20% and up to 35% in risk groups. Known risk groups for IH are abdominal aortic aneurysm and obesity. Our hypothesis is that parastomal hernia (PSH) might also represent a risk factor for developing IH. Identifying risk factors can help determine the need for preventive measures like primary mesh augmentation.
Methods
In a multi-center cross-sectional study, all patients who were operated between 2002 and 2010 by means of a Hartmann procedure or abdominoperineal resection were invited for a follow-up visit to our outpatient clinic. Primary outcome measures were the prevalence of IH and PSH. All possible risk factors for IH were scored. A physical examination was performed and, when available, CT-scans were scored for IH and PSH.
Results
A total of 150 patients were seen in the outpatient clinic. The median follow-up was 49 months (30-75). IH had a prevalence of 37.1% and PSH had a prevalence of 52.3% during physical examination. During CT-scan examination prevalance was even higher, beeing 48.3% and 52.9%. IH and PSH were both present in the same patient in 30% of all examined, and in 35.6% after CT-scan examination. PSH was found to be a statistically signi cant risk factor for IH in univariate and multivariate logistic regression analyses of variance, with an Odds Ratio (OR) of 7.2 (95% CI 3.3 – 15.7). In addition, an emergency operation was found to be a risk factor for IH with an OR of 5.8 in the multivariate analyses.
Conclusions
Patients with a PSH have a seven times higher chance of developing an IH compared to patients without PSH.
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