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Midline abdominal wall incisional hernia after aortic reconstructive surgery: a prospective study
Mario Gruppo1, Franco Mazzalai, Renata Lorenzetti
1Vascular Surgery Section, University of Padua, School of Medicine, Padova, Italy.
Surgery
|March 3, 2012
Summary
Midline abdominal wall incisional hernias (MAIH) occur similarly after aortic aneurysm repair and revascularization. A suture length-to-wound length ratio of at least 4:1 is recommended to reduce MAIH formation.
Area of Science:
- Vascular Surgery
- Abdominal Surgery
- Surgical Outcomes Research
Background:
- Midline abdominal wall incisional hernias (MAIH) are a known complication following abdominal surgery.
- Elective open repair of abdominal aortic aneurysms (AAA) and aortoiliac occlusive disease (AOD) frequently involve midline incisions.
Purpose of the Study:
- To evaluate the incidence of midline abdominal wall incisional hernia (MAIH) after elective open repair of abdominal aortic aneurysms (AAA) and revascularization for aortoiliac occlusive disease (AOD).
- To identify predictors of MAIH formation in patients undergoing aortic reconstructive surgery.
Main Methods:
- A prospective study included 1,065 patients undergoing elective aortic reconstructive surgery via a primary midline abdominal incision.
- Patients were followed for MAIH development for a mean of 6.4 years, with examinations every 6 months for 2 years, then annually.
- Wound closure techniques, specifically the suture length-to-wound length (SL:WL) ratio, were recorded.
Main Results:
- The overall incidence of MAIH was 11.6% (124 of 1,065 patients), with similar rates in AAA (12.4%) and AOD (11.2%) groups.
- A suture length-to-wound length (SL:WL) ratio of less than 4:1 was identified as the only independent predictor of MAIH in both AAA and AOD patients.
- Only 3 wound infections occurred, none resulting in MAIH.
Conclusions:
- The incidence of midline abdominal wall incisional hernia (MAIH) is similar for abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AOD) repair.
- Wound closure technique, specifically achieving a suture length-to-wound length (SL:WL) ratio of at least 4:1, is crucial in preventing MAIH.
- Further research is needed to explore other modifiable technical and perioperative factors to decrease MAIH incidence.
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