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Incisional hernia after McBurney incision: retrospective case-control study of risk factors and surgical treatment
Marcelo A Beltrán1, Karina S Cruces
1Department Of Surgery, Hospital De Ovalle, Manuel Antonio Caro 2629, La Serena, IV Region, PO Box 912, La Serena, Chile. Beltran_01@Yahoo.Com
Background:
Few reports have dealt with incisional hernias originating at a McBurney incision after appendectomy. The purpose of the present study was to identify risk factors for development of incisional hernia at a McBurney incision, and to describe our experience with the treatment of this kind of hernia.
Patients And Methods:
We reviewed 4,862 files of patients older than 15 years of age operated on for acute appendicitis. Some 4,523 (93%) of that group were operated on through a McBurney incision, and 34 (0.7%) of them developed incisional hernia. To identify risk factors for development of incisional hernia we used binary logistic regression analysis.
Results:
The following risk factors were identified: female gender (p = 0.011), diabetes (p < 0.0001), peritonitis, abscess or phlegmon as the cause of the first operation (p = 0.009), wound infection (p = 0.034), seroma (p = 0.023), the use of catgut to suture the aponeurosis (p < 0.0001), and interrupted suture to the aponeurotic layer (p = 0.046). Twenty-two hernias were repaired with Mayo-herniorrhaphy and 12 with a subaponeurotic polypropylene prosthesis. Recurrences developed in 3 patients, none in hernias repaired with prosthesis.
Conclusions:
The risk of incisional hernia after a McBurney incision for acute appendicitis was very low; we recommend the repair of this uncommon incisional hernia with current standard tension-free prosthetic techniques.
Insights
Incisional hernias after appendectomy via McBurney incision are rare. Key risk factors include female gender, diabetes, wound complications, and specific suture techniques. Prosthetic repair shows no recurrence.
Area of Science:
- General Surgery
- Abdominal Surgery
- Hernia Repair
Background:
- Incisional hernias at McBurney sites post-appendectomy are infrequently reported.
- Understanding risk factors and treatment outcomes is crucial for surgical practice.
Purpose of the Study:
- To identify risk factors for incisional hernia development following McBurney incision for appendectomy.
- To evaluate the clinical experience with treating these specific hernias.
Main Methods:
- Retrospective review of 4,862 patients over 15 undergoing appendectomy.
- Analysis of 4,523 patients operated via McBurney incision, identifying 34 with incisional hernias.
- Binary logistic regression used to determine risk factors for hernia development.
Main Results:
- Identified risk factors: female gender, diabetes, peritonitis/abscess/phlegmon, wound infection, seroma, catgut sutures, and interrupted aponeurotic sutures.
- Hernia repair methods included Mayo-herniorrhaphy (22 cases) and polypropylene prosthesis (12 cases).
- No recurrences were observed in the 12 hernias repaired with prosthetic material.
Conclusions:
- The incidence of incisional hernia after McBurney incision for appendicitis is low.
- Tension-free prosthetic repair is recommended for this uncommon incisional hernia due to superior outcomes.