Page 137 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Figure 2. Midline shift after enterostomy creation.
However, the 21 patients identi ed with SSI were equally divided across the patients with and without hernia; SSI therefore cannot be responsible for the high rates of hernia which we found. HMP showed a higher incidence (59.4%) of hernia compared to APR (31.4%). However, the results of the multivariate regression analysis showed - not HMP - but the emergency setting in which the HMP usually took place to constitute a risk factor for IH. Patients operated in an emergency setting had a 5.8 times higher odds of IH than patients not operated in an emergency setting. Relatively few articles have been published on this subject regarding emergency operations and hernia formation(33, 34). Patients operated in an emergency setting are generally in a more weakened state both pre-operatively and post-operatively, are more often subject of intra-abdominal contamination than other patients and also generally have high intra-abdominal pressure; the possibility of tension-free closure is thus reduced strongly (35).
Limitations
There are several weaknesses with regard to this study and most of them are due to the cross-sectional design. For instance, as all patients were seen at the
Parastomal and incisional hernia
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