A clinical study of postoperative complications following repair of ventral hernia using mesh among patients admitted in Coimbatore Medical College Hospital

INTRODUCTION: Hernia is derived from the Greek word ‘ Hernios’ meaning an offshoot, a budding or bulge. The Latin word hernia means a rupture or tear. VENTRAL HERNIA: It is a collective term of all extrusions of peritoneum and abdominal contents through the anterolateral abdominal wall excluding groin hernias. It can be spontaneous or acquired. This includes 1. Incisional / postoperative hernias: It is the result of failure of the lines of closure of the abdominal wall following laparotomy. The approximated tissues separate and the abdominal organs, mainly bowel bulge through the gap which is covered from inside outwards with peritoneum, scar tissue and skin. These are the most common type of hernias next to groin hernias. 2. Umbilical hernias: Umbilical scar in infants does not close completely or if it fails and stretches in later years, the abdominal contents protrude through the opening and constitute an umbilical hernia. 3. Paraumbilical hernias: Midline hernias abutting on the umbilicus superiorly and inferiorly are called paraumbilical hernias. 4. Epigastric hernia: They are protrusions of abdominal contents through the interstices between the deccusating fibres of the sheet muscles of the abdominal wall in the midline (linea alba), between the xiphoid process and the umbilicus. 5. Spigelian hernia: Protrusion through spigelian fascia of anterior abdominal wall. Occurs between umbilicus and arcuate line. Out of these ventral hernias incisional hernia is the most common. Then comes umbilical, paraumbilical and epigastric hernias. Spigelian hernias are very rare. AIM OF THE STUDY: 1. To study the short-term post operative complications following repair of ventral hernia using mesh. 2. To identify the risk factor for the complications. Along with this study history and etiology of ventral hernia, age and sex incidence, clinical presentation, risk factors, pre operative preparations and post operative care will be discussed. This study also helps to find out the risk factors in previous surgery responsible for development of incisional hernia. MATERIALS AND METHODS: All patients detected to have ventral hernia during the period of January 2009 to July 2011 were studied at Coimbatore Medical College Hospital. The total number of cases studied were 50 which included all forms of ventral hernia such as umbilical, paraumblical, epigastric and incisional hernia. Inclusion Criteria: 1. All cases of ventral hernia, 2. Patients above the age of 12 years. Exclusion Criteria: 1. Patients below the age of 12 years, 2. Cases where follow up is not possible Eg: Patients is not tracable during post operative period. 3. Ventral hernia less than 3 cms. 4. Ventral hernia presenting with strangulation where mesh repair is not feasible. All patients underwent thorough clinical examination and a detailed history of earlier operation were asked. All patients were simultaneously evaluated for any systemic disease or any precipitating cause. Patients who had associated hypertension, diabetes mellitus or cough were controlled and monitored pre operatively. RESULTS: The total number of cases studied in this series was 50 cases of ventral hernia admitted in Coimbatore Medical College hospital from Jan 2010 to July 2011 Study design: A prospective clinical study consisting of 50 patients with who underwent mesh repair was undertaken to study the short term complications following the ventral hernia repair with prosthetic mesh and its association with risk factors. CONCLUSION: 1. Ventral hernia is the second most common hernia after inguinal hernia. 2. Maximum age incidence in this study is between 41 to 50 year age group, more in females compared to males. 3. All ventral hernias have a female preponderance. 4. In all ventral hernias, the common presentation is swelling. 5. The incidence of incisional hernia is more common after gynaecological surgeries (57%). 6. Incisional hernia more common in infraumbilical incision in primary surgery. 7. The occurrence of incisional hernia more after an emergency primary surgery. 8. Wound sepsis during the post operative period of primary surgery is the commonest factor responsible for development of incisional hernia. 9. The most common post operative complications were seroma, wound infection and wound dehiscence. 10. Patients with obesity are 6.5 times more likely to get post operative complications with p value= 0.0085. 11. Patients with diabetes mellitus are more likely to get post operative complications with p value= 0.0046 12. Short term complications in our series are equal to literature standards. 13. Thorough preoperative skin preparation, selection of appropriate operation with expertly administration of anesthesia are essential for excellent results. Meticulous operative technique, use of non absorbable sutures to close musculoaponeurotic layer is also needed for good results. Musculoaponeurotic layer closed with simple anatomical closure or double breasting, avoidance of any undue tension on suture line, use of suction drain, perioperative good antibiotic coverage, Nasogastric aspiration, prompt treatment of paralytic ileus by good electrolyte balance, good chest physiotherapy are all essential steps to reduce the complication rates to a minimum and the recurrence rates to nil