Hernias, aortic surgery and review of the literature on incisional hernias
Abstract
Objectives: To study the relation of incisional hernias after abdominal aortic surgery and to study the recommendations for prevention of incisional hernias in general.
Methods: An extensive search in Pub-Med was conducted. We used the following MeSH terms; abdominal aortic aneurysm; incisional hernia; inguinal hernia; incisional hernia and radiology, abdominal wound closure, we also did a “snow-falling” search with the above terms.
Results: Still today there is not unanimity concerning the relation of aortic or aortoiliac pathology and incisional or inguinal hernias although the majority of studies suggest that there is a possible increase in the prevalence of incisional hernias after aortic surgery.
Conclusions: In order to lessen the possibilities of incisional hernias suture length to wound length ration should be more that 4:1. Sutures should be tied without excessive tension and to use either a slowly absorbable or nonabsorbable suture material. Use a suture USP 2/0 mounted on a small needle. Place stitches in the aponeurosis only and 5 to 8mm from the wound edge and 4 to 5 mm apart.
Downloads
References
Hall KA, et al. Abdominal wall hernias in patients with abdominal aortic aneurysmal versus aortoiliac occlusive disease. Am J Surg 1995;170(6): 572–576.
Muysoms F, et al. Classification of primary and incisional abdominal wall hernias. Hernia 2009;13(4): 407–414.
Korenkov M, et al. Classification and surgical treatment of incisional hernia. Langenbeck's Arch Surg 2001;386(1): 65–73.
Baucom RB, et al. Prospective evaluation of surgeon physical examination for detection of incisional hernias. J Am Coll Surg 2014;218(3): 363–366.
Bhangu A, et al. Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy. Hernia 2013;17(4): 445–455.
Van't Riet M, et al. Meta-analysis of techniques for closure of midline abdominal incisions. BJS 2002;89(11): 1350–1356.
Diener MK, et al. Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg 2010;251(5): 843–856.
Norton J, et al. Surgery: Basic science and clinical evidence. 2001: Springer Science & Business Media.
Sorensen LT, et al. Smoking is a risk factor for incisional hernia. Arch Surg 2005;140(2): 119–123.
Sanders DL, AN Kingsnorth. The modern management of incisional hernias. BMJ 2012: 344.
Gislason HGJ, Soreide O. Burst abdomen and incisional hernia after major gastrointestinal operations – comparison of three closure techniques. Eur J Surg 1995;161: 349–354.
Harding K, et al. Late development of incisional hernia: and unrecognised problem. BMJ (Clinical research ed.) 1983;286(6364):519.
Hesselink V, et al. An evaluation of risk factors in incisional hernia recurrence. SGO 1993;176(3): 228–234.
Pollock A, Greenall M, Evans M. Single-layer mass closure of major laparotomies by continuous suturing. J Roy Soc Med 1989;72(12):889.
Lord RS, et al. Transverse abdominal incisions compared with midline incisions for elective infrarenal aortic reconstruction: predisposition to incisional hernia in patients with increased intraoperative blood loss. J Vasc Surg 1994;20(1): 27–33.
Fassiadis N, et al. Randomized clinical trial of vertical or transverse laparotomy for abdominal aortic aneurysm repair. BJS 2005;92(10):1208–1211.
Holland A, et al. Incisional hernias are more common in aneurysmal arterial disease. Eur J Vasc End Surg 1996;12(2): 196–200.
Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg 2000;231(3):436.
Henriksen N, et al. Lack of association between inguinal hernia and abdominal aortic aneurysm in a population based male cohort. BJS 2013;100(11): 1478–1482.
Stevick C, et al. Ventral hernia following abdominal aortic reconstruction. Am Surg 1988;54(5): 287–289.
Mudge M, Hughes L. Incisional hernia: a 10 year prospective study of incidence and attitudes. BJS 1985;72(1): 70–71.
Johnson B, Sharp R, Thursby P. Incisional hernias: incidence following abdominal aortic aneurysm repair. J Card Surg 1995;36(5): 487–490.
Lord RS, et al. Transverse abdominal incisions compared with midline incisions for elective infrarenal aortic reconstruction: predisposition to incisional hernia in patients with increased intraoperative blood loss. Journal of vascular surgery, 1994;20(1): 27–33.
Augestad KM, Wilsgaard T, Solberg S. Incisional hernia after surgery for abdominal aortic aneurysm. Tidsskr Nor Laegforen 2002;122(1):22.
Takagi H, et al. Postoperative incision hernia in patients with abdominal aortic aneurysm and aortoiliac occlusive disease: a systematic review. Eur J Vas End Surg 2007;33(2): 177–181.
Adye, B, Luna G. Incidence of abdominal wall hernia in aortic surgery. Am J Surg 1998;175(5): 400–402.
Musella M, et al. Magnetic resonance imaging and abdominal wall hernias in aortic surgery. JACS 2001; 193(4): 392–395.
Luijendijk RW, et al. A comparison of suture repair with mesh repair for incisional hernia. NEJM 2000;343(6): 392–398.
Papadimitriou D, et al. Incidence of abdominal wall hernias in patients undergoing aortic surgery for aneurysm or occlusive disease. Vasa 2002;31(2): 111–114.
Liapis CD, et al. Incidence of incisional hernias in patients operated on for aneurysm or occlusive disease. Am Surg 2004;70(6): 550–552.
Raffetto JD, et al. Incision and abdominal wall hernias in patients with aneurysm or occlusive aortic disease. J Vasc Surg 2003;37(6):1150–1154.
Antoniou GA, et al. Abdominal aortic aneurysm and abdominal wall hernia as manifestations of a connective tissue disorder. J Vasc Surg 2011;54(4): 1175–1181.
Israelsson L. Incisional hernias in patients with aortic aneurysmal disease: the importance of suture technique. Eur J Vas End Surg 1999;17(2): 133–135.
Cannon DJ, Casteel L, Read RC, Abdominal aortic aneurysm, Leriche's syndrome, inguinal herniation, and smoking. Arch Surg 1984;119(4):387–389.
Cannon DJ, Read RC, Metastatic emphysema: a mechanism for acquiring inguinal herniation. Ann Surg 1981;194(3): 270.
Pleumeekers H, et al. Prevalence of aortic aneurysm in men with a history of inguinal hernia repair. BJS 1999;86(9): 1155–1158.
Antoniou GA, et al. Increased prevalence of abdominal aortic aneurysm in patients undergoing inguinal hernia repair compared with patients without hernia receiving aneurysm screening. J Vasc Surg 2011;53(5): 1184–1188.
Lehnert B, Wadouh F. High coincidence of inguinal hernias and abdominal aortic aneurysms. Ann Vasc Surg 1992;6(2): 134–137.
Golledge J, Reeve T, Norman PE. Abdominal aortic aneurysm, inguinal hernias and emphysema. ANZ J Surg 2008;78(11): 1034–1034.
Grondal N, et al. Study protocol The Viborg vascular (VIVA) screening trial of 65–74 year old men in the central region of Denmark: study protocol. Trials 2010.
Lindholt JS, et al. Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BJS 2005;330(7494): 750.
Ellis H, Gajraj H, George C. Incisional hernias: when do they occur? BJS 1983;70(5): 290–291.
Krukowski Z, Matheson N. A Button hole™ incisional hernia: A late complication of abdominal wound closure with continuous nonabsorbable sutures. BJS 1987;74(9): 824–825.
Honig MP. Mason RA, Giron F, Wound complications of the retroperitoneal approach to the aorta and iliac vessels. J Vasc Surg 1992;15(1): 28–34.
Peck JJ, et al. Extraperitoneal approach for aortoiliac reconstruction of the abdominal aorta. Am J Surg 1986;151(5): 620–623.
Luijendijk, RW. Incisional Hernia: lisk factors, prevention, and repair. 2000: Erasmus MC: University Medical Center Rotterdam.
Hesselink, V, et al. An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 1993;176(3): 228–234.
Luijendijk RW, et al. Incisional hernia recurrence following "vest-overpants" or vertical Mayo repair of primary hernias of the midline. W J Surg 1997;21(1): 62–66.
Manninen M, Lavonius M, Perhoniemi V. Results of incisional hernia repair. A retrospective study of 172 unselected hernioplasties. Eur J Surg 1991;157(1): 29–31.
Sitzmann J, McFadden D. The internal retention repair of massive ventral hernia. Am Surg 1989;55(12): 719–723.
Langer C, et al. Problem of recurrent incisional hernia after mesh repair of the abdominal wall. Chirurg 2001;72(8): 927–933.
Israelsson LA, Millbourn D. Closing midline abdominal incisions. Langenbecks Arch Surg 2012;397(8): 1201–1207.
O'Dwyer P, Courtney C. Factors involved in abdominal wall closure and subsequent incisional hernia. Surgeon 2003;1(1): 17–22.
Douglas D. The healing of aponeurotic incisions. BJS 1952;40(159):79–84.
Dudley H. Layered and mass closure of the abdominal wall, A Theoretical and Experimental Analysis. BJS 1970;57(9): 664–667.
Goligher J, et al. A controlled clinical trial of three methods of closure of laparotomy wounds. BJS 1975;62(10): 823–829.
Irvin T, Koffman C, Duthie H. Layer closure of laparotomy wounds with absorbable and non-absorbable suture materials. BJS 1976;63(10): 793–796.
Israelsson L, Jonssonv T. Closure of midline laparotomy incisions with polydioxanone and nylon: the importance of suture technique. BJS 1994;81(11): 1606–1608.
Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 2005;62(2): 220–225.
Wissing J, et al. Fascia closure after midline laparotomy: results of a randomized trial. BJS 1987;74(8): 738–741.
Corman ML, Veidenheimer MC, Coller JA. Controlled clinical trial of three suture materials for abdominal wall closure after bowel operations. Am J Surg 1981;141(4): 510–513.
Askew A. A comparison of upper abdominal wound closure with monofilament nylon and polyglycolic acid. Aus N Z J Surg 1983;53(4):353–356.
Niggebrugge A, et al. Continuous double loop closure: a new technique for repair of laparotomy wounds. BJS 1997;84(2): 258–261.
Mayer A, et al. Compression suture of the abdominal wall: a controlled trial in 302 major laparotomies. BJS 1981;68(9): 632–634.
Langer S, Christiansen J. Long-term results after incisional hernia repair. Acta Chir Scand 1984;151(3): 217–219.
Pless J, Lontoft E. Giant ventral hernias and their repair. Scand J Plast Reconstr Surg Hand Surg 1984;18(2): 209–213.
Bauer JJ, et al. Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE). Ann of Surg 1987;206(6): 765.
Rubio P. New technique for repairing large ventral incisional hernias with Marlex mesh. SGO 1986;162(3): 275–276.
Read RC, Yoder G. Recent trends in the management of incisional herniation. Arch Surg 1989;124(4): 485–488.
Jenkins T. The burst abdominal wound: a mechanical approach. BJS 1976;63(11): 873–876.
Israelsson LA, Millbourn D. Prevention of incisional hernias: how to close a midline incision. Surg Clin North Am 2013;93(5): 1027–1040.
Israelsson L, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. BJS 1993;80(10): 1284–1286.
Millbourn D, Cengiz Y. Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 2009;144(11): 1056–1059.
Gruppo M, et al. Midline abdominal wall incisional hernia after aortic reconstructive surgery: a prospective study. Surgery 2012;151(6):882–888.
Israelsson LA, Jonsson T. Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg 1997;163(3): 175–180.
Israelsson L, Jonsson L, Wimo A. Cost analysis of incisional hernia repair by suture or mesh. Hernia 2003;7(3): 114–117.
Janes A, Cengiz Y, Israelsson LA. Preventing parastomal hernia with a prosthetic mesh: a 5-year follow up of a randomized study. W J Surg 2009;33(1): 118–121.
Hidalgo M, et al. Incisional hernia in patients at risk: can it be prevented? Hernia 2011;15(4): 371–375.
El-Khadrawy O, et al. Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients. Hernia 2009;13(3):267–274.
Bevis P, et al. Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. BJS 2010;97(10): 1497–1502.
Bali C, et al. A comparative study of sutured versus bovine pericardium mesh abdominal closure after open abdominal aortic aneurysm repair. Hernia 2014: 1–5.
O'Hare J, Ward J, Earnshaw J. Late results of mesh wound closure after elective open aortic aneurysm repair. Eur J Vasc End Surg 2007;33(4): 412–413.
Rogers M, McCarthy R, Earnshaw J. Prevention of incisional hernia after aortic aneurysm repair. Eur J Vas End Surg 2003;26(5): 519–522.
Campbell JA, et al. A biomechanical study of suture pullout in linea alba. Surgery;1989 106(5): 888–892.
Hogstrom H, Haglund U, Zederfeldt B. Suture technique and early breaking strength of intestinal anastomoses and laparotomy wounds. Acta Chir Scand 1984;151(5): 441–443.
Millbourn D. Closure of midline abdominal incisions with small stitches: studies on wound complications and health economy. Studies on wound complications and health economy [Doctoral Thesis]. Umea (Sweden): Umea University, 2012.
Deerenberg EB, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 2015.
Sanders RJ, DiClementi D, Ireland K. Principles of abdominal wound closure: I. Animal studies. Arch Surg 1977;112(10): 1184–1187.
Hoer J, et al. Influence of suture technique on laparotomy wound healing: an experimental study in the rat. Langenbeck's Arch Surg 2001 386(3): 218–223.
Cengiz Y, Blomquist P, Israelsson LA, Small tissue bites and wound strength: an experimental study. Arch Surg 2001 136(3): 272–275.
Miller PA, et al. Imaging of abdominal hernias. Radiographics 1995 15(2): 333–347.
Bennett H, Balfe D. MR imaging of the peritoneum and abdominal wall. Magn Reson Imaging Clin N Am 1995;3(1): 99–120.
Mueller M, Truong SN, Schumpelick V. Sonographic diagnosis of abdominal wall relaxation. J Cl Ultr 1999;27(4): 183–186.
Grolleau J, et al. Imaging of abdominal wall eventration: role and value of x-ray computed tomography. Ann Chir 1996.
Beck WC, et al. Comparative effectiveness of dynamic abdominal sonography for hernia vs computed tomography in the diagnosis of incisional hernia. J Am Coll Surg 2013;216(3): 447–453.
Gossios K, et al. Value of CT after laparoscopic repair of postsurgical ventral hernia. Abdom Imaging 2003;28(1): 99–102.
De la Pena CG, Romero JV, Garcia JD. The value of CT diagnosis of hernia recurrence after prosthetic repair of ventral incisional hernias. Eur Radiolog 2001;11(7): 1161–1164.
Ghahremani GG, et al. CT diagnosis of occult incisional hernias. AJR Am J Roetgenol 1987;148(1): 139–142.
Rodriguez HE, et al. Abdominal wall hernias after open abdominal aortic aneurysm repair: prospective radiographic detection and clinical implications. Vasc Endovascular Surg 2004;38(3): 237–240.
Copyright (c) 2016 Acta Chirurgica Croatica
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors hereby authorize the Acta Chirurgica Croatica (ACC) to publish their work.
The authors are aware that although ACC is Open Access journal, the copyright of all material published is vested in ACC. Open access articles are freely available to read, download, and share from the time of publication under the terms of the Creative Commons License Attribution ‐ NonCommerical No Derivative (CC BY‐NC‐ND) license. This license does not permit reuse for any commercial purposes nor does it cover the reuse or modification of individual elements of the work (such as figures, tables, etc.) in the creation of derivative works without specific permission of ACC and appropriate acknowledgment of its source. The authors permit ACC to allow third parties to copy any part of the work without asking for permission, provided that the reference to the source is given and that this is not done for commercial purposes. Except for copyright, other proprietary rights related to the work (e.g., patent or other rights to any process or procedure) shall be retained by the author. To reproduce any text, figures, tables, or illustrations from this work in future works of their own, the author must obtain written permission from ACC.
Each of the author(s) hereby also grants permission to ACC to use such author’s name and likeness in connection with any past, present or future promotional activity by ACC, including, but not limited to, promotions for upcoming issues or publications, circulation solicitations, advertising or other publications in connection with ACC. Also, each of the author(s) hereby grants permission to ACC to use the manuscript in editorial research related to the improvement of editorial conduct, decision making, and issues related to peer review.
Each of the author(s) hereby releases and shall indemnify and hold harmless ACC and its successors, assigns, licensees, officers, directors, employees, and their respective heirs and representatives from and against any and all liabilities, losses, damages and expenses arising out of any claims of any kind that may be asserted against any of them based in whole or in part on any breach of the author(s)’ representations or warranties herein or in the work or anything contained in the work, including but not limited to any claims for copyright infringement or violation of any rights of privacy or publicity.
