Page 132 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 6
any abdominal wall gap with or without a bulge in the area of a postoperative scar perceptible or palpable by clinical examination and/or imaging(16). PSH was de ned as any palpable defect or bulge adjacent to the stoma when the patient is supine with elevated legs or erect and coughing or straining(17). The length of the incision scar was measured and, when present, the position and size of the hernia was measured and scored using the European Hernia Society (EHS) classi cation system(18). If present, postoperative CT scans were scored for PSH and IH independently by two investigators.
Information on possible risk factors for herniation was obtained: gender, age, weight, height, body mass index (BMI), current smoking (de ned as 5 cigarettes per day or more), corticosteroid use (current user of any dose), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) (de ned as current user of speci c diabetic type of drugs or insuline use), previous midline incision, AAA, previous hernia (inguinal, umbilical, incisional, hiatal), postoperative complications (surgical site infection (SSI), burst abdomen, pneumonia, ileus), emergency operation, chemotherapy (de ned as any type or dose of oral or intravenous chemotherapy), radiotherapy (de ned as any type or dose of radiotherapy) and physical strenuous work.
Chi-Square (X2) tests and Mann-Whitney U tests were used to compare risk factors for IH and PSH. Univariate and multivariate logistical regression analyses were conducted to predict Odds ratios (OR) of potential risk factors. Risk factors that were discovered in this study or are known in the literature will be added to the multivariate logistic regression analyses. All statistical calculations were done using IBM SPSS© 17 Software (SPSS, Chicago, Illinois, USA). Signi cance was assumed at P <0.05.
Results
Between 2002 and 2010, a total of 574 patients received either APR or HMP. At the moment of our study: 244 of these patients were deceased; 87 could not be reached due to relocation or invalid contact information; and 54 patients did not wish to participate due to diminished physical condition or other reasons. Of the remaining 189 patients who were thus willing to participate 23 were excluded due to removal of the stoma and 16 did not show up for follow-up (Figure 1). Of the 150 included patients, 118 (78.7%) patients had undergone APR, 89 (59.3%) were male, the mean age was 67.4 years (SD 10.2), mean BMI
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