Background
Conventional open surgery is still important beside endovascular surgery in the management
of abdominal aortic aneurysms, with less reinterventions in the long-term follow-up.
Incisional hernias are the major complication open surgery in the mid- and long term.
The occurrence of this late complication could be due to the choice of the incision,
median or transverse. The objectives of our retrospective and bicentric study were
to characterize the long-term risk factors for incisional hernias after open surgery
for abdominal aortic aneurysms, in particular by comparing the 2 types of laparotomy,
and to determine the prevalence of the operated and not operated incisional hernias.
Materials and methods
Between January 2009 and December 2011, all the patients having elective open surgery
for abdominal aortic aneurysm (AAA) by midline laparotomy at the University hospital
of Besancon or by transversal laparotomy at the University Hospital of Strasbourg
were included retrospectively. The demographic data, the time of diagnosis of the
incisional hernia and the parietal reinterventions were collected during a 5-year
postoperative follow-up. A univariate and multivariate Cox model was used for the
statistical analysis to determine the long-term risk factors for the appearance of
an incisional hernia.
Results
During the study period, 223 patients presenting with AAA were included, 112 of them
were operated by a midline laparotomy and 111 by a transverse laparotomy. The mean
age of the patients was 69 ± 8,4years and 208 (93.3%) were men. The 5-year prevalence
of incisional hernias was 14.3% (32), and 20 of these hernias (9%) had to be operated.
Eighteen hernias (16.1%) occurred after a midline laparotomy and 14 (12.6%) after
a transverse incision (P = 0.30). In univariate analysis, obstructive chronic pulmonary disease was the only
significant risk factor for incisional hernia (P = 0.01) and an age over 65 years appeared to protect against this risk (P = 0.049). These results were confirmed by multivariate analysis, which showed that
obstructive chronic pulmonary disease was an independent risk factor for incisional
hernia (HR = 2.35, 95% CI 1.16–4.75), and that an age over 65 years was a protective
factor (HR = 0.49 95% IC 0.00–0.99).
Conclusions
The type of laparotomy did not modify the rate of incisional hernias. We showed that
only 9% of the patients had to be operated to treat an incisional hernia during the
first 5 years after surgery for AAA in our bicentric study. Chronic obstructive pulmonary
disease was the only independent risk factor for the occurrence of an incisional hernia.
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Article Info
Publication History
Published online: January 29, 2022
Accepted:
October 19,
2021
Received in revised form:
October 18,
2021
Received:
August 12,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
