[Surgery of incisional hernia and its prognosis--statistical analysis in 657 patients]

In order to study the problems of surgery for incisional hernia and its prognosis, 657 patients who had undergone surgery for incisional hernia between January 1974 and December 1983 in 27 hospitals were analyzed statistically by questionnaire survey. These patients consisted of 571 in whom surgery was performed for the first time and 86 in whom surgery was carried out for recurrent hernia. The ratio of male to female patients with initial surgery was 1:2.4, showing a higher frequency in females than in males. Initial surgery was most frequently carried out in the patients' 50s and 60s. The most common procedure which caused hernia was a median incision in 299 (51.6%), followed by an incision of the right hypogastrium for appendectomy in 211 (36.4%). There were many patients with systemic complications such as obesity, diabetes and asthma. The recurrence rate after radical surgery for incisional hernia was 9.1%. There was a tendency for the recurrence rate to be high in elderly patients and those who had had systemic complications (obesity, diabetes and asthma) preoperatively. The rate was very high, 33.3%, in patients with postoperative wound infection. The recurrence rate in patients with surgery for recurrent hernia was about three times as high as the 7.3% for patients with initial surgery. When the rate was determined by procedure, it was 2.4% for patients treated by a mesh prosthesis, 9.4% for those treated by celiorrhaphy and closure, and 16.7% for those treated by the overlap method. Mesh prosthesis was considered the best procedure, particularly for recurrent hernia.