Aetiology, Presentation And Outcome Of Mesh Repair Among Sudanese Patients With Incisional Hernia

Abstract

Background: Incisional hernia is an important health problem affecting young and middle age groups, presented either as emergency or electively. Many of them were recurrent cases and some of them of repeated recurrence, with very difficult management. This study has been set out to evaluate the aetiological factors, the clinical presentations and the early complications following mesh repair of the incisional hernia among Sudanese patients. Methods: This is a prospective study carried out at Elribat University, Khartoum Teaching and Soba University Hospitals in the period from June 2005 to June 2006 in 63 patients who underwent incisional hernia repair utilizing the onlay mesh repair technique. Results: Among the patients presented with incisional hernia in this study, caesarian section was the commonest cause of the primary surgery (79%) and far less common was gastrointestinal operations (11.1%). Obesity (89%), multiparity (88% ) and longitudinal abdominal incisions (73% ) were the most recognized risk factors for incisional hernia, and to lesser degree were bronchial asthma (11.2%), steroid medication (6.4%), IX diabetes mellitus (9.6%), abdominal mass (4.8%) and hard working (6.3%). The vast majority of patients were females in their child bearing ages (81%), with the adverse effects of pregnancies and labors in the course and management of incisional hernias and impracticality to use the mesh if pregnancy is anticipated. The main clinical presentations were pain and reducible lump (84%), but 16% of patients presented with irreducible hernias. 38.1% of patients presented with recurrent hernias, some of them with multiple recurrences. The mean size of hernial defects was 38 cm², and the main contents were both bowel and omentum (57.1%). Most patients presented within the first year after the primary surgery (74.6%). Seventy three percent of the patients had no complications within three months following the mesh repair of the hernias, the minority developed complications (1.6% of the patients developed haematoma, same percentage developed DVT, 9.6% developed surgical site infection (SSI), 14.3% developed seroma) comparable to that in the literature records, and all were treated conservatively. There was significant proportional association between the occurrence of postoperative complications X following the initial operations and following the hernial repair (P=0.005). Conclusion: caesarian section was the commonest cause of the primary surgery. The main clinical presentations was reducible lump. There is no significant complications within three months following the mesh repair of the hernias.