Comparison of Surgical Treatment Results of Large Incisional Hernias

Introduction

Incisional hernias are one of the most common complications after abdominal surgery. Surgical repairs of

large incisional hernias have higher complications and recurrence rates compared to smaller incisional

hernia repairs. For this reason, it is a more difficult and experience-requiring application for surgeons. In

addition, there is no evidence-based consensus in the literature regarding the optimal surgical treatment of

large incisional hernias. The aim of this study is to compare the results of the three most common surgical

treatment methods used in a tertiary university hospital for the repair of large incisional hernias in terms of

patients' characteristics, recurrence, and complication rates of the treatment methods.

Methods

Between 2014 and 2020, 366 patients with incisional hernias with facial defects larger than 10 cm in a

tertiary medical faculty hospital located in eastern Turkey were analyzed. Patients were divided into three

groups according to the surgical method used: open onlay prolene mesh (OPM) method, laparoscopic

intraperitoneal sublay dual mesh (IPSDM) method, and open IPSDM method. Postoperative complications

were divided into five groups as follows: wound complications, complications due to surgical procedures,

medical complications, recurrences, and mortality. Treatment methods were compared according to the

demographic characteristics of the patients and the postoperative complication rates.

Results

Of the patients, 141 were male and 225 were female, and the mean age was 58.0 ± 28 years. Of the

patients, 81.9% were operated on with the open OPM, 10.9% with the laparoscopic IPSDM, and 7.1% with

the open IPSDM. Wound complications occurred in 26.7% of patients, surgical complications in 3.2%,

medical complications in 6.5%, recurrence in 9.2%, and mortality in 0.8% of patients. Total wound

complications were significantly higher in the open OPM group (30%) (p = 0.009). Total surgery

complications were significantly higher in the laparoscopic IPSDM group (15%) (p = 0.002). There was no

significant difference between groups for medical complications (p = 0.540). Although no recurrence was

observed in the open IPSDM group, no significant difference was observed between the groups (p = 0.099).

There was no difference in mortality rates between the groups (p = 0.450). The overall complication rate was

highest in the open OPM group (48.3%) and lowest in the open IPSDM group (27%) (p = 0.092). The operative

time was found to be significantly shorter in open IPSDM (p < 0.001). The length of hospital stay was highest

in the open OPM group and lowest in the open IPSDM group (p = 0.450).

Conclusions

Although hernia defect is greater in the open IPSDM compared to other methods, this method is more

advantageous in terms of the complication rate associated with the surgical procedure, the overall

complication rate, the duration of surgery, and the recurrence rate. Laparoscopic