Reducing the incidence of incisional hernias following open gastric bypass surgery

Abdominal wall hernias are a common complication following open gastric bypass (RYGBP) surgery. In an effort to reduce the incidence of incisional hernias with our form of open RYGBP, progressively smaller, upper midline epigastric incisions have been utilized along with permanent sutures. The purpose of this study is to analyze whether incision location, size and choice of suture material affect the incidence of incisional hernias following open RYGBP.

Clinically evident incisional hernias and other wound complications and non-wound related complications were analyzed for 1,180 consecutive primary open proximal RYGBP procedures performed between August 2002 and June 2006. Progressively smaller, upper midline incisions were utilized during the time period of the study.

Smaller incisions limited to the upper abdomen and approximated with permanent sutures were associated with significantly fewer hernias (P<0.01), wound dehiscences (P<0.03), eviscerations (P<0.03) and wound infections (P<0.03). Smaller incisions may also be associated with less postoperative discomfort.

A reduction in incision size, the avoidance of the periumbilical region and the use of nonabsorbable sutures has significantly reduced the incidence of incisional hernias and acute fascial disruptions with our form of open RYGBP. These findings are consistent with LaPlace's law regarding wall tension and vessel radius. In addition, we found smaller incisions to be associated with fewer infections and seromas and less postoperative discomfort. A reduction in incision size has not been associated with an increase in morbidity or mortality or changes in the operative time.