Emergency treatment of complicated incisional hernias: a case study

Since January 1999 till July 2008, 89 patients (55 males and 34 females) were treated for complicated incisional hernias in emergency. The patients were divided in two groups: Group I consisting of 33 patients that were treated with prosthesis apposition and Group II, consisting of 56 patients that were treated by performing a direct abdominal wall muscles suture.All the patients underwent a 6-month follow up; we noticed 9 recurrences (9/56, 16%) in the patients treated with direct abdominal wall muscles suture and 1 recurrence (1/33, 3%) in the group of patients treated with the prosthesis apposition.According to our experience, the emergency treatment of complicated incisional hernias through prosthesis apposition is always feasible and ensures less post-operative complications (16% vs 21,2%) and recurrences (3% vs 16%) compared to the patients treated with direct muscular suture.Repair of abdominal wall hernia represents the most common group of operatios performed by general surgeons all around the world. Incisional hernia is a serious complication after abdominal surgery which occurs in 11-23% of laparotomies [1].In 2003 it was estimated that over 100,000 ventral incisional hernia repairs were performed in the US. Risk factors for incisional hernia formation and preventive strategies are not clearly defined, but according to data from literature, significant demographic factors influencing incisional hernia incidence are age (> 45 years) and male gender. Preoperative anaemia (Hb < 100 g/l) and BMI > 25, associated with previous laparotomies and postoperative catecholamin-therapy also seem to play an important role [2]. The tension-free repair is one of the key concepts in hernia surgery. The use of a mesh prosthesis decreases the recurrence rates, particularly for inguinal and incisional hernias. Recently, the laparoscopic approach extended the options and approaches for repairing the fascial defect.The emergency treatment of incisional hernias is not frequent