American Journal of Medical Sciences and Medicine
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American Journal of Medical Sciences and Medicine. 2021, 9(1), 13-16
DOI: 10.12691/ajmsm-9-1-3
Open AccessArticle

Incisional Hernia in Pregnancy at the University of Port Harcourt Teaching Hospital, Southern Nigeria

Wichendu Promise1, and Gbeneol Tombari2

1Consultant General Surgeon, University of Port Harcourt Teaching Hospital, Choba, Port Harcourt

2Consultant plastic and Reconstructive Surgeon, University of Port Harcourt Teaching hospital, Choba, Port Harcourt

Pub. Date: January 28, 2021

Cite this paper:
Wichendu Promise and Gbeneol Tombari. Incisional Hernia in Pregnancy at the University of Port Harcourt Teaching Hospital, Southern Nigeria. American Journal of Medical Sciences and Medicine. 2021; 9(1):13-16. doi: 10.12691/ajmsm-9-1-3

Abstract

Background: Aim: incisional hernias occur through a weakness at the site of abdominal wall closure after surgery and is a common condition encountered in day to day surgical practice. It lends itself to multiple and varied aetiological factors. Despite recent advances in the management of incisional hernias, the recurrence rate is still high. Incisional hernia is uncommon in pregnancy, however when it occurs serious and life-threatening complications may arise. Thus there is a need to revisit the possible aetiological factors that may give rise to incisional hernia in our locality so as to prevent them. To our knowledge no such study has ever been undertaking here. Materials and methods This is a five-year retrospective survey conducted at the antenatal clinic of the university of Port Harcourt Teaching hospital in southern Nigeria between January 2008 to December 2013. A total of one hundred and seven patients with incisional hernia were identified and some aetiological factors for incisional hernia in the patient were deciphered. Each patient’s abdomen was examined to confirm the presence of incisional hernia, and type of surgical incision used. All these were collated and analysed. Results: Obesity was the commonest risk factor 78 (72.9%), while wound sepsis accounted for 61 (57.0%) Nearly all patients had longitudinal incisions 105 (98.1%) while for some 11 (10.3%), there were no identifiable risk factors. Also, Caesarean section accounted for majority of the surgeries that led to incisional hernia in the study population 72(67.3%) followed by myomectomy. Emergency surgeries were complicated by incisional hernia than elective Conclusion: This study found that the commonest aetiological factors for incisional hernia in our locality but not limited to: Obesity, wound sepsis, emergency surgeries as well as longitudinal incisions. Interestingly these are all modifiable risk factors and are amenable to health education and sound surgical techniques.

Keywords:
incisional hernia abdomen pregnancy aetiology sepsis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Malangoni MA, Hernias RMJ. In: Townsend et al., editors. Townsend: Sabiston Textbook of Surgery. 19th ed. New York: Saunders; 2012. pp. 1114-1140.
 
[2]  Sanders DL, Kingsnorth AN. The modern management of incisional hernia. BMJ. 2012; 344: 37-42.
 
[3]  Mudge M, Hughes LE. Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 1985; 72: 70.
 
[4]  Fink C, Baumann P, Wente MN et al: Incisional hernia rate 3 years after midline laparotomy. Br J Surg 2014; 101: 51-54.
 
[5]  Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: A prospective study of 1129 major laparotomies. BMJ. 1982; 284: 931-933.
 
[6]  Poulose BK, Shelton J, Phillips S et al: Epidemiology and cost of ventral hernia repair: Making the case for hernia research. Hernia 2012; 16: 179-183.
 
[7]  Santora TA, Rosalyn JJ. Incisional hernia. Surg Clin North Am 1993; 73: 557
 
[8]  Regnard JF, Hay JM, Rea S. Ventral incisional hernias: incidence, date of recurrence, localization, and risk factors. Ital J Surg Sci 1988; 3: 259
 
[9]  Read RC, Yoder G. Recent trends in the management of incisional herniation. Arch Surg 1989; 124:485
 
[10]  Greenall MJ, Evans M, Pollack AV. Midline or transverse laparotomy? A random controlled clinical trial. Part I: influence on healing. Br J Surg 1980; 67: 188.
 
[11]  Makela JT, Kiviniemi H, Juvonen T, et al. Factors influencing wound dehiscence after midline laparotomy. Am J Surg 1995; 170: 387.
 
[12]  Adesunkanmi AR, Faleyimu B. Incidence and aetiological factors of incisional hernia in post-caesarean operations in a Nigerian hospital. J Obstet Gynaecol 2003; 23: 258-60.
 
[13]  Wall PD, Deucy EE, Glantz JC, Pressman EK. Vertical skin incisions and wound complications in the obese parturient. Obstet Gynecol 2003; 102(5 Pt 1): 952-6.
 
[14]  Girotto JA, Malaisrie SC, Bulkely G, Manson PN. Recurrent ventral herniation in Ehlers-Danlos syndrome. Plastic and Reconstructive Surgery. 2000; 106: 1520-1526.
 
[15]  Klinge U, Binnebosel M, Mertens PR. Are collagens the culprits in the development of incisional and inguinal hernia disease? Hernia. 2006; 10: 472-477.
 
[16]  Dare FO, Makinde OO, Lawal OO. Gravid uterus in abdominal wall hernia of a Nigerian woman. Int J Obstet Gynecol. 1990; 32: 377-379.
 
[17]  Boys CE. Strangulated hernia containing pregnant uterus at term. Am J Obstet Gynecol. 1945; 50: 450-452.
 
[18]  Banerjee N, Deka D, Sinha A, Prasrad R, Takkar D. Gravid uterus in an incisional hernia. J Obstet Gynaecol Res. 2001; 27: 77-79. [PubMed]
 
[19]  Nagpal M, Kaur S. Herniated pregnant uterus with bleeding from previous abdominal scar. J Obstet Gynaecol India. 2003; 53: 283.
 
[20]  Heniford BT. SAGES guidelines for laparoscopic ventral hernia repair. Surgical Endoscopy. 2016; 30(8): 3161-3162
 
[21]  Souza JM, Dumanian GA. Routine use of bioprosthetic mesh is not necessary: A retrospective review of 100 consecutive cases of intraabdominal midweight polypropylene mesh for ventral hernia repair. Surgery. 2013; 153(3): 393-399.
 
[22]  de Vries HS, Smeeing D, Lourens H, Kruyt PM, Mollen RMHG. Long-term clinical experience with laparoscopic ventral hernia repair using a ParietexTM composite mesh in severely obese and non-severe obese patients: A single center cohort study. Minimally Invasive Therapy & Allied Technologies. 2018; 11: 1-5.
 
[23]  Millikan KW, Baptisa M, Amin B, et al. Intraperitoneal underlay ventral hernia repair utilizing bilayer ePTFE and polypropylene mesh. Am Surg 2003; 69: 258.
 
[24]  McLanahan D, King LT, Weems C, et al. Retrorectus prosthetic mesh repair of midline abdominal hernia. Am J Surg 1997; 173: 445.
 
[25]  den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW. (2008). Open surgical procedures for incisional hernias. In: Tuinebreijer WE (ed) Cochrane database of systematic reviews. Wiley, Chichester, p CD006438.
 
[26]  Junge K, Klinge U, Prescher A, Giboni P, Niewiera M, Schumpelick V. Elasticity of the anterior abdominal wall and impact for reparation of incisional hernia using mesh implants. Hernia 2001; 5: 113-8.
 
[27]   Kim WB, Kim J, Boo YJ, Park SH, Song TJ, Suh SO (2009) Successful vaginal delivery following laparoscopic abdominal wall reconstruction in an adult survivor of an omphalocele without prior surgical repair: report of a case. Hernia 13:431-434.
 
[28]  Schoenmaeckers E, Stirler V, Raymakers J, Rakic S. Pregnancy following laparoscopic mesh repair of ventral abdominal wall hernia. JSLS 2012;16: 85-8
 
[29]  Malhotra M, Sharma JB, Wadhwa L et al. Successful pregnancy outcome after cesarean section in a case of gravid uterus growing in an incisional hernia of the anterior abdominal wall. Indian J Med Sci 2003; 57: 501-503
 
[30]  AltchekA,RudickJ. Preperitoneal herniorrhaphy: Adjunct to cesarean section. Obstet Gynecol 1987; 70: 470-471
 
[31]  Ochsenbein-Kolble N, Demartines N, Ochsenbein-Imhof N, Zimmermann R. Cesarean section and simultaneous hernia repair. Arch Surg 2004; 139: 893-985
 
[32]  Bani D. Relaxin: A pleiotropic hormone. Gen Pharmacol 1997; 28: 13-22.
 
[33]  Oma E, Henriksen NA, Jensen KK: Ventral hernia and pregnancy: A systematic review. Am J Surg 2019; 217: 163-168.
 
[34]  Agbakwuru E, Olabanji J, Alatise O, Okwerekwu R, Esimai O. Incisional Hernia in Women: Predisposing Factors and Management Where Mesh is not Readily Available Libyan J Med. 2009 Jun 1; 4(2): 66-9.
 
[35]  Ahmed Alenazi A, Alsharif MM, Hussain MA, Alenezi NG, Alenazi AA, Almadani SA, Alanazi NH, Alshammari JH, Altimyat AO, Alanazi TH. (2017). Prevalence, risk factors and character of abdominal hernia in Arar City, Northern Saudi Arabia in 2017. Electronic physician, 9 (7): 4806.
 
[36]  Höer J, Lawong G, Klinge U, Schumpelick V. Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg 2002; 73(5): 474-80.
 
[37]  Carlson MA, Ludwig KA, Condon RE. Ventral hernia and other complications of 1000 midline incision. South Med J 1995; 88(4): 450-453.
 
[38]  Sugerman H.J. (2001). Hernia and Obesity. In: Bendavid R., Abrahamson J., Arregui M.E., Flament J.B., Phillips E.H. (eds) Abdominal Wall Hernias. Springer, New York, NY: 672-674.
 
[39]  Greenall MJ, Evans M, Pollock AV. Midline or transverse laparotomy? A random controlled clinical trial. Part 2: Influence on postoperative puhnonary complications. Br J Surg. 1980; 67: 191-4.
 
[40]  Jenkins TPN. The burst abdominal wound: A mechanical approach. Br J Surg 1976; 63: 873-876D.