Clinical study and Management of Incisional Hernia

INTRODUCTION: Incisional hernia is a protrusion of abdominal viscera through the sites of previous operation or traumatic wound of the abdominal wall.The lower abdominal incisions are associated with highest incidence of incisional hernia The pressure in the lower abdomen is more than upper abdomen and the posterior rectus sheath is deficient below the umbilicus and the stress and strain on lower abdomen predispose to herniations. AIMS AND OBJECTIVES: • To analyse various etiological factors for incisional hernia. • To study the description of cases in relation to age an dsex. • To study the details of the previous surgeries undergone. • To study various surgical modalities in the treatment of incisional hernia. MATERIALS AND METHODS: INCLUSION CRITERIA: • All patients admitted in general surgery ward diagnosed as incisional Hernia. • All patients who have undergone single/multiple abdominal surgeries(lap/open). • All patients with recurrent incisional hernias. • Age group between 20-70. EXCLUSION CRITERIA: • Extremes of age 70. • Any ventral hernia other than incisional hernia. • Patients who expire without undergoing surgery. • Patients who did not undergo/not willing for surgery. METHODOLOGY: After getting Ethical committee apapproval patient satisfying inclusion criteria were selected and Informed consent obtained.Patient details regarding clinical history were collected and tone and previous nature of surgery were determined.Preoperative assessment of the patient is done and type of surgery for each patient is individualised and planned.post procedure patient if followed up and post operative complications if any noted.Data is then analysed and conclusion is arrived. RESULTS: In the current study done among 50 patients , 25 patients were in the age group of 40 – 50 years which was calculated as 50 %. 21 patients were in the age group of 51 – 60 years which was calculated as 42%. The remaining four patients were in the age group of 61 – 70 years which was calculated as 8%. In our study, out of 50 patients, 36 patients were females which was calculated as 76 . The remaining 14 patients were males which was calculated as 28%. In our study, out of 50 patients, 22 patients of incisional hernia had previous surgery of trans-abdominal tubectomy which was calculated as 44%. Patients had previous surgery of lower segment 99aparotom section which was calculated as 36%. Six patients had hysterectomy done which was calculated as 12%. Two patients had history of surgery done for duodenal perforation which was calculated as 4 % and the remaining two patients had operated for ileal perforation which was calculated as 4%. In our study group, out of 50 patients, forty patients had undergone surgery through Transverse infra umbilical which accounts for about 80% 12% which accounts for Infra umbilical midline incision. CONCLUSION: Incisional hernia is one of the preventable Surgical conditions when combined with effective operative technique and post operative care. But it also depends upon the patients factors and their compliance to post operative instructions.Once Incisional hernia has been diagnosed it needs to corrected surgically. The type of surgery is individualised to each patient.Laparoscopic mesh repair has evolved which can prevent furthur new scars.Transversus abdominis muscle release has now revolutionised the hernia society with its huge impact on large ventral hernias with loss of domain.Though mortality is minimum,the morbidity is sufficient enough to incapacitate the patient. And hence proper preoperative management with meticulous surgical technique and post operative care is essential to prevent the occurrence of incisional hernia