Open extraperitoneal mesh repair for abdominal wall hernias in females.

OBJECTIVE: To determine the outcome of treatment in terms of infection and recurrence using open extraperitoneal mesh repair technique.

STUDY DESIGN: Quasi-experimental study.

PLACE AND DURATION OF STUDY: The department of General Surgery, Combined Military Hospital, Bahawal Nagar Cantonment, from February 2006 to November 2008.

METHODOLOGY: Female patients with abdominal wall hernias with defect of 4 cm or more were studied. A history of previous surgery along with clinical findings on examination like size of defect and previous scar were noted. At surgery, hernial sacs were carefully opened and omental and intestinal adhesions were carefully separated. Polypropylene mesh was placed over extraperitoneal space and secured with interrupted vicryl 2/0 sutures. Redivac drains were placed over the mesh and the fascial repair. The patients were discharged on the 3rd - 4th postoperative day and were followed-up at 3 monthly intervals for postoperative sequelae like seroma, haematoma, infection and recurrence.

RESULTS: There were 32 cases with a mean age of 41.25 + or - 10.79 years. The mean follow-up period was 15.78 + or - 9.02 months. Previous abdominal surgical intervention was found in 16 (50%) cases. Out of those, 14 (43.7%) had defects through the previous scar. A history of multiple caesarean sections alone, or in combination with either hysterectomy or laparotomy in the last 5 years was present in 7 patients. There were 12 (37.5%) cases of paraumbilical hernia, 4 (12.5%) of a recurrent paraumbilical hernia, 5 (15.6%) epigastric hernia, 2 (6.2%) mix hernia, 7 (21.8%) incisional hernia and 1 (3.1%) each of Spigelian hernia and postlaparoscopic cholecystectomy portal (paraumbilical) hernia. The mean size of the defect was 4.9 cm in primary paraumbilical hernias and 7.2 cm in recurrent paraumbilical hernias. The mean size of the defect in incisional hernias was 9.4 cm, larger than all other types. Superficial wound infection was seen in only 1 morbidly obese (BMI > 30) patient. No case of seroma, haematoma, deep seated abscess or recurrence was noted in the follow-up period.

CONCLUSION: Abdominal wall hernias are common in female patients, especially those with previous surgical intervention. Open extraperitoneal mesh repair with placement of redivac drains is an effective method for the management of abdominal wall hernias with a smaller complication rate and less recurrence.