A Prospective Observational Study of Abdominal Wall Hernias and Its Management in a Tertiary Care Hospital

Abstract

Introduction: Abdominal wall hernia is a common surgical condition affecting all ages and both sexes. It is an abnormal protrusion of a peritoneal lined sac through the muscular covering of the abdomen. The clinical manifestations range from small incidentally found defects to giant and complicated hernias with loss of abdominal domain. Symptoms range from none or few to severe pain and life-threatening conditions.

Materials and Methods: A prospective observational study was conducted in Department of General Surgery, ACSR Govt Medical College, Nellore and Andhra Pradesh over a period from September 2023 to August 2024 with 102 patients included in the study. Patients with age >15 years who had herniation at site of previous surgical scar were chosen for the study. Observations were made with regard to duration and ease of operation, wound complications, mesh infections, hospital stay, morbidity and recurrence. Diagnosis was made with clinical examination, USG abdomen and X-ray abdomen. All the patients were assessed preoperatively, intra-operatively and post-operatively, and the findings were recorded in a pre-structured proforma.

Results: 56 males and 46 females were included. The mean age was 42.3 years. Most common cause of IH was post-operative wound infection (47.1%). Maximum cases were following emergency surgery (88.2%). Midline incision contributes maximum number (52.9%) followed by Pfannenstiel incision (25.4%). Open hernioplasty was the most common procedure (58.8%) followed by anatomical repair (19.6%) and laparoscopic hernioplasty (15.6%). Recurrence with suture repair was 10%, open mesh repair 3.3% and no recurrence was observed following laparoscopic repair.

Conclusion: Prevention of IH is to be taken care of, by avoiding infection during index operation with thorough peritoneal toileting, proper surgical techniques and appropriate antibiotics. Although laparoscopic mesh repair needs more operating time and skill, it has lesser blood loss, hospital stay and recurrence rate when compared to other procedures.