SURGICAL AND PROCEDURAL RISK FACTORS ASSOCIATED WITH INCISIONAL HERNIA
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Keywords
Incisional hernia, surgical site infection, lower midline incision, exploratory laparotomy, anaemia, constipation, risk factors, suture material, India, prospective study.
Abstract
Background: Incisional hernia, a common complication of abdominal surgery, results from fascial dehiscence and impaired wound healing. Despite advances in surgical techniques, it continues to pose significant clinical and socioeconomic challenges. Identifying and analyzing surgical and perioperative risk factors is crucial for prevention and effective management, particularly in Tier II Indian populations where data remain limited.
Aim: To evaluate the impact of previous surgeries, incision type, surgical site infection (SSI), perioperative factors, and associated comorbidities on the development of incisional hernia.
Methodology: This prospective observational study was conducted over 18 months at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun. Forty patients aged 18–70 years with clinically diagnosed incisional hernias were included. Data on prior surgeries, incision types, SSI, comorbid conditions, nutritional status, and suture materials used were collected through structured proforma and clinical examination. Statistical analysis was performed to assess associations.
Results: Most patients (87.5%) developed incisional hernia after a single surgery, with exploratory laparotomy (42.5%), abdominal hysterectomy (22.5%), and open cholecystectomy (12.5%) as common antecedents. Lower midline incisions (47.5%) and a history of SSI (52.5%) were predominant. Hernias developed most frequently within 1 year post-surgery (42.5%), with chronic constipation (32.5%) and cough (15%) as leading risk factors. Nutritional deficiencies were notable, with anaemia in 40%, hypoproteinaemia in 15%, and 85% having undergone closure with non-absorbable sutures.
Conclusion: Incisional hernia is frequently associated with a single prior abdominal surgery, particularly exploratory laparotomy, and is significantly linked to lower midline incisions and SSI. Constipation and anaemia emerged as important modifiable perioperative risk factors. These findings highlight the need for targeted preventive strategies, optimized surgical techniques, and nutritional assessment to reduce hernia occurrence and recurrence.
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Dr Avneesh Kumar
Assistant Professor, Dept of General Surgery, SGRRIM&HS
Dr Rajesh Kumar Sahu
Assistant Professor, Dept of General Surgery, SGRRIM&HS
Dr Praveen Jose
Senior Resident, Dept of General Surgery, SGRRIM&HS
Dr Rajesh Kumar
Professor, Dept of General Surgery, SGRRIM&HS