Page 131 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Introduction
Patients diagnosed with abdominal pathology can be operated by open midline laparotomy. Incisional hernia (IH) is the most frequent complication following
midline laparotomy, with an incidence of 11-20%(1-3). The presence of IH is
associated with pain, impaired quality of life and potentially life-threatening complications such as incarceration or strangulation of the bowel(4, 5). In 25%
of patients surgically treated for abdominal pathology, a stoma is necessary (6).
Parastomal hernia (PSH) is a frequent complication following stoma creation,
with an incidence of up to 48% (7). Clinical ndings in our center suggest that
PSH might be a risk factor for later IH. PSH disrupts the normal abdominal wall 6 anatomy and might therefore induce a higher incidence of IH. Currently known
risk factors for IH development are obesity and abdominal aortic aneurysm (AAA), with incidences of up to 35%(8-13). Identi cation of risk groups gives surgeons the possibility to adapt or change their techniques such as primary mesh augmentation in order to prevent IH occurrence(9, 14). A better understanding of the etiology of IH may also be obtained with greater insight into the association between PSH and IH. We hypothesized that the presence of a PSH would be a risk factor for the occurrence of IH occurrence.
Methods
A cross-sectional study was conducted at the Erasmus University Medical Center (EMC) in Rotterdam and the Albert Schweitzer Hospital (ASZ) in Dordrecht, The Netherlands. All patients who had been operated either using a Hartmann procedure (HMP) or abdominoperineal resection (APR) between 2002 and 2010 were screened for eligibility. Patients with HMP and APR were included because the end colostomy created during these operations is permanent (APR) or is not restored in most cases (HMP)(15). Patients who died and patients with anastomosis created in a second operation to restore the natural faecal route were excluded.
Those patients willing to participate provided their informed consent and were seen in our outpatient clinic. Follow-up examination was conducted by two physicians experienced in hernia investigation. Physical examination was performed to determine the presence of IH and/or PSH. IH was de ned as
Parastomal and incisional hernia
129