Clinical study and management of incisional hernia by onlay or preperitoneal mesh repair: A Prospective study in rural set up

Background and Aim:  Incisional hernias occur as a result of excessive tension and inadequate healing of a previous incision, which is often associated with surgical site infection. The aim of this study was to assess the magnitude of various factors leading to development of incisional hernias and to evaluate the technique of various mesh repair in incisional hernias in terms of postoperative complications, postoperative hospital stay and recurrences if any. Materials and Methods: This Prospective study was conducted in NKPSIMS, Nagpur from July 2010- Nov 2012. A minimum of 64 patients of Incisional Hernia were included in the study. Factors were tabulated and statistically analysed to study their contributions. Results : The mean age of the patient presenting with incisional hernia was 41.85 yrs. There were 52 (81.2%) women and 12 (18.75%) men. In our study 71% of incisional hernias occurred in infraumbilical midline scar. 78% of the incisional hernias followed operations on the female pelvic organs. Infection in post-operative period did seem to be the commonest predisposing factor (37.5%) for weakening of the scar. Incisional hernias were treated by mesh repair either Onlay or Preperitoneal. Conclusion: - Incisional hernia is a common surgical problem as a result of a failure of fascial tissues to heal following surgical interventions. The seeds of incisional hernia are sown at the time of the operation or during convalescence. The choice of operative technique is critical . Preperitoneal mesh repair is better than the Onlay mesh repair.