Incisional abdominal hernias repaired with simultaneous intra-abdominal procedure may have poor outcomes
Patients who develop ventral incisional abdominal hernias frequently have other pathology within their abdomen that requires attention. Addressing both issues during the same operation can be a double-edged sword. On the one hand, incisional hernias need to be repaired in order to avoid potential emergency surgery for incarceration or strangulation of the intestines. We know from previous studies that placement of a non-absorbable mesh during incisional hernia repair has resulted in a fifty percent decrease in hernia recurrence compared with primary suture repair. On the other hand, placing mesh under the abdominal wall during the same procedure in which the surgeon(s) perform another procedure on the intestines may result in a high risk of mesh infection. Recently, a group of surgeons evaluated the effect of performing concomitant surgical procedures with incisional hernia repair with respect to outcomes (Altom, et al. Outcomes for Incisional Hernia Repair in Patients Undergoing Concomitant Surgical Procedures. The American Surgeon. Vol 78, No 2 Feb 2012, p243.). The authors performed a retrospective analysis of these incisional hernia cases; here is what they found:
- Of 1485 elective incisional hernia repairs performed, 131 (8.8%) underwent a concomitant procedure; of which 75 (5%) were same site procedures.
- Concomitant procedures included: Inguinal hernia repair, colon surgery, soft tissue surgery, gall bladder removal, small intestinal surgery, stomach surgery, anorectal surgery, urologic surgery and vascular surgery.
- Only 20% of cases had permanent mesh placed when a concomitant dirty procedure was performed (i.e. colon resection)
- There were no differences in complications in patients who underwent incisional hernia repair and concomitant “other site procedures.”
- Same site concomitant procedures (i.e. simultaneous colon surgery) were more likely to develop complications, require mesh removal and develop recurrence of the hernia.
- 52% of patients who had “same site” concomitant surgery along with incisional hernia repair developed hernia recurrence, required mesh removal or both. (compared with 28% for “other site” simultaneous surgery, and 33% for incisional hernia repair alone.
In summary, incisional hernia repair with concomitant same-site procedures was associated with significantly worse outcomes. Patients with “other site” concomitant procedures had similar to improved outcomes with respect to patients having incisional hernia repair alone.