Long-term results of incisional hernia treatment

Ventral hernia is a common problem in general surgery practice. Incisional hernia can develop in 15-25% of patients after abdominal surgery. The aim of this study was to compare two different methods of incisional hernia surgery.

A retrospective analysis of database of surgery department from 1997 to 2000 was performed. All patients were divided into two groups. The first group patients were operated using open suture repair (keel technique); the second group patients--using open mesh repair (onlay technique). Long-term follow-up was done by a mail questionnaire. A special questionnaire was sent to all patients. Postoperative evaluation included pain and discomfort in the abdomen, physical activity, and recurrence rate after operation. Statistical evaluation was conduced using descriptive analysis: the unpaired Student t test to compare parametric criterions between two study groups, Mann-Whitney U test to compare the unpaired nonparametric criterions between two study groups, and chi2 test to investigate nonparametric criterions between these groups.

A total of 202 patients (51 males, 151 females) with incisional hernia were operated during 1997-2000. One hundred seventy-one patients were in the keel technique group, and 31 patients in the onlay technique group. There were no significantly differences in age and sex between these groups. The hospitalization time was significantly longer in the open mesh repair group. The postoperative complication (wound seroma and suppuration) rate was significantly higher in the onlay technique group. One hundred sixty-one patients (79.7%) answered the questionnaire (133 in the keel technique group, 28 the in onlay technique group). The patients' return to physical activity after surgery was significantly longer in the keel technique group. Forty-one patients (31%) had hernia recurrence in the keel technique group and 3 patients (11%) in the onlay technique group (P<0.05). There were no postoperative deaths in both groups.

The rates of postoperative therapeutic complications and hernia recurrence are significantly lower after open mesh repair surgery. Return to normal physical activity after surgery is significantly longer after open suture repair surgery.