Incisional Hernia: Early Complication of Abdominal Surgery |
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Authors: | Jacobus WA Burger MD Johan F Lange PhD Jens A Halm MD Gert-Jan Kleinrensink PhD Hans Jeekel PhD |
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Institution: | (1) Department of General Surgery, Erasmus University Medical Center, PO Box 2040, Rotterdam, CA Rotterdam, 3000, The Netherlands;(2) Lowlands Institute of Surgical Anatomy, Erasmus University Medical Center, Rotterdam, CA Rotterdam, 3000, The Netherlands;(3) Department of General Surgery, Medisch Centrum Rijnmond Zuid, Rotterdam, The Netherlands |
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Abstract: | It has been suggested that early development of the incisional hernia is caused by perioperative factors, such as surgical
technique and wound infection. Late development may implicate other factors, such as connective tissue disorders. Our objective
was to establish whether incisional hernia develops early after abdominal surgery (i.e., during the first postoperative month). Patients who underwent a midline laparotomy between 1995 and 2001 and had had a computed
tomography (CT) scan of the abdomen during the first postoperative month were identified retrospectively. The distance between
the two rectus abdominis muscles was measured on these CT scans, after which several parameters were calculated to predict
incisional hernia development. Hernia development was established clinically through chart review or, if the chart review
was inconclusive, by an outpatient clinic visit. The average and maximum distances between the left and right rectus abdominis
muscles were significantly larger in patients with subsequent incisional hernia development than in those without an incisional
hernia (P < 0.0001). Altogether, 92% (23/25) of incisional hernia patients had a maximum distance of more than 25 mm compared to only
18% (5/28) of patients without an incisional hernia (P < 0.0001). Incisional hernia occurrence can thus be predicted by measuring the distance between the rectus abdominis muscles
on a postoperative CT scan. Although an incisional hernia develops within weeks of surgery, its clinical manifestation may
take years. Our results indicate perioperative factors as the main cause of incisional hernias. Therefore, incisional hernia
prevention should focus on perioperative factors. |
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