Factors affecting wound complications in repair of ventral hernias

Wound-related complications are common after incisional hernia repair. Prophylactic antibiotic use, placement of subcutaneous drains, and technical factors such as mesh implantation reportedly influence the incidence of these complications. Our aim was to study the incidence of wound complications in incisional hernia repairs and to determine whether use of antibiotics, drains, or mesh influence these rates. Two hundred fifty hernias were repaired in 206 patients over a 14-year period. Simple repair was performed in 151 patients while mesh was used in 99 repairs. Mesh repair was used in larger hernias, required longer operating time, and had greater blood loss than simple repair. Twenty-eight per cent of repairs with mesh were for recurrent hernias compared with 14 per cent for simple repair (P < .05). Overall, 34 per cent of patients had wound-related complications. Chronic obstructive pulmonary disease, obesity, steroid therapy, and previous wound infection were not associated with increased risk for wound complications. The use of mesh and hernia defect > 10 cm were associated with significantly more wound complications. The incidence of seroma was increased in mesh repairs (21% vs 7%), as were total wound complications (44% vs 26%; P < 0.05). A suprafascial onlay mesh technique resulted in more frequent seroma formation. Patients undergoing mesh repair were more likely to receive antibiotics (91% vs 71%) and have subcutaneous drains placed (57% vs 25%; P < 0.05) compared to simple primary repair. Neither antibiotics nor drains had an effect on the incidence of wound complications within each group. Overall, wound infections were more frequent when drains were placed. We conclude that repair of incisional hernias is associated with substantial risk of wound-related complications. Mesh is used for repair of larger and more complex hernias and is associated with increased risk of wound complications. Abnormal fluid collections are the most frequent problem, but the use of drains does not reduce the incidence of these complications.