Short Term Incidence of Incisional Hernia after Emergency Midline Laparotomy

Author(s): Shakeel Ahmad Mir1 , Waseem Akram2 , Ishfaq Ahmad Gilkar3 , Rajandeep Singh Bali4 , Javeed Iqbal Mughal5

BACKGROUND Incisional hernia is defined by The European Hernia Society as “any abdominal wall gap with or without a bulge in the area of postoperative scar perceptible or palpable by clinical examination or imaging”. Incisional hernia is the most frequent postoperative complication following general surgery. The cumulative incidence has remained constant despite several attempts to improve laparotomy closure. In addition to the surgical closure technique, individual biological and patient dependent risk factors play a key role. METHODS The present observational study was conducted in the Postgraduate Department of General Surgery, Government Medical College, Srinagar, at SMHS Hospital from August 2017 to March 2019 and included 120 patients. All patients were operated upon through a midline incision. The patients were divided into two groups. Group A included those patients who had peritonitis and Group B included those patients who had haemoperitoneum. RESULTS In our study it was found that wound infection developed in 19 patients in group A and 8 patients in group B. 11 patients in group A and 5 patients in group B developed wound hematoma. Wound dehiscence occurred in 5 patients in group A and 2 patients in group B. Re-exploration were needed in 1 patient in group A and 2 patients in Group B. Abdominal distention developed in 15 patients in group A and 9 patients in group B. Chest infection developed in 21 patients in group A and 11 patients in group B. At 1-year post-operative follow up, it was found that there was significant increase in incidence of incisional hernia in group A, i.e. 16.66% (10 patients) as compared to group B, i.e. 8.3% (5 patients) with p value of 0.025. CONCLUSIONS Midline laparotomy incision remains the best incision to assess and access the peritoneal cavity for emergency midline laparotomy with regard to septic or haemorrhagic peritonitis (generalized). Comorbidities increase the risk of developing incisional hernia, more so, in septic peritonitis than haemorrhagic peritonitis.