Subxiphoid incisional hernias after median sternotomy

Area of Science:

• Cardiothoracic Surgery
• Surgical Oncology
• Hernia Repair

Background:

• Subxiphoid hernias pose significant challenges in surgical repair.
• Identifying risk factors for incisional hernia formation post-median sternotomy is crucial for patient outcomes.

Purpose of the Study:

• To investigate and identify key risk factors associated with the development of subxiphoid incisional hernias following median sternotomy.
• To compare patient characteristics and perioperative factors between those who develop hernias and those who do not.

Main Methods:

• A retrospective review of patients undergoing subxiphoid incisional hernia repair (1995-2002) was performed.
• Comparison with a matched cohort undergoing similar cardiothoracic procedures, analyzing body mass index (BMI), comorbidities, complications, and wound infections.
• Statistical analysis included Student's t-test, chi-square, and Kaplan-Meier analysis.

Main Results:

• Higher BMI (29.6 vs 27.2, p=0.01), increased length of stay (16.3 vs 10.2 days, p=0.03), and a higher incidence of sternal wound infections (18% vs 3.9%, p=0.02) were observed in the hernia group.
• Multivariate analysis indicated transfusion requirements (p=0.015) and BMI (p=0.058) as significant factors.
• Recurrence rates were higher in patients without mesh repair (43% vs 32%) and those with prior sternal wound infections (75% developed recurrence).

Conclusions:

• Transfusion requirements, elevated BMI, and sternal wound infections are potential risk factors for subxiphoid hernias post-median sternotomy.
• Sternal wound infections significantly increase the likelihood of recurrent incisional hernias, highlighting the importance of wound management.