Incisional Hernia Repair by Preperitoneal (Sublay) Mesh Implantation

Abstract

Incisional Hernia is a common surgical condition with a reported incidence of 2-11% following all laparatomies. Results of tissue repair have been disappointing. The optimal approach for abdominal incisional hernias is still under discussion. Aims: To evaluate the technique of preperitoneal (sublay) mesh repair of incisional hernias. Patients and Methods: This preoperative study of  consecutive  50 cases was done from January .2004 to January 2006 using a computerized database. Preperitoneal (sublay) mesh implantation was done in all the 50 cases. Follow up of 12-24 months was carried in the OPD and on telephone with regards to postoperative complications, hospital stay and recurrences if any. Results: In our study of fifty patients, eighty percent of females (n= 40) outnumbered twenty percent males (n=10). The female to male ratio was 4: 1 and the highest incidence was in the 5^th decade of life. The main presenting  feature was swelling

of the abdomen in all the fifty patients (100%)  in the vicinity of the previous operative scar. In sixty percent of patients (n=30), the most common incision leading to incisional hernia was the midline incision of abdomen followed by Pfannensteil’s  incision in fourteen percent ( n=7) and paramedian incision in twelve ( n=6). Major wound infection occurred in   two patients (4%) only but without the removal of mesh. Forty patients (80%) attended for follow up ranging from 12 months to 24 months. Twenty seven patients (67.5%) attended OPD for follow up and thirteen patients (32.5%) replied the questions on phone. No recurrence was noted in follow up group. Conclusion: Based on this study, we conclude that preperitoneal (sublay) mesh repair is the ideal technique for incisional hernia. Though still there are few publications regarding this technique of repair.

Key Words: Incisional hernia, preperitoneal (sublay), mesh repair