Incidence of abdominal wall hernia in aortic surgery

True aneurysms of the abdominal aorta and its branches are at least in part due to defects in the structural integrity of the arterial wall. Whether the defect is isolated to the vascular wall is unclear. If the structural weakness involves other tissues, patients with aneurysmal disease should have a higher incidence of collagen and fascial defects, such as abdominal and inguinal hernias.

We reviewed 100 patients who underwent elective aortic reconstruction for aneurysmal or occlusive disease. All patients were operated on by the same group of vascular surgeons, through a midline incision, with fascia closed using running absorbable suture. Midline incisional and inguinal hernias were identified, and all patients were followed up for at least 1 year. Comparisons between groups were made for established risk factors for ventral hernias.

Incisional hernias occurred in 18 of 58 (31%) aneurysm patients, compared with 5 of 42 (12%) occlusive disease patients (P = 0.025). Inguinal hernias occurred in 11 of 58 (19%) aneurysm patients versus 2 of 42 (5%) occlusive disease patients (P = 0.037). Risk factors were equally distributed between the two groups. Neither the size of the aneurysm nor the presence of an iliac artery aneurysm affected the incidence of abdominal wall hernias in the aneurysm patients.

This study emphasizes the increased incidence of abdominal wall hernias in patients undergoing aortic surgery for aneurysm disease compared with aortoiliac occlusive disease. The size of the aneurysm and the association of an iliac artery aneurysm did not affect the incidence of hernias among these patients. Genetic and biochemical abnormalities are considered as possible explanations.