Abstract

Introduction: The term ventral hernia refers to the hernia of anterior abdominal wall. Treatment of hernia has different types of surgical repair procedures, that are laparoscopic or open; by suturing anatomical or mesh repair. Use of mesh in hernia repair had improved the outcome, mostly the recurrence. Mesh can be placed in different planes in abdominal wall; Overlay, retromuscular, preperitoneal or intraperitoneal. Accordingly, these different planes had different outcomes. This study aimed to determine the postoperative complications of overlay hernioplasty.

Methods: This is a descriptive and prospective hospital-based study performed in two hospitals (AL Noor private hospital and 22 May public hospital), during January through December 2022 at Aden city. It included 150 patients diagnosed as ventral abdomen hernia (both types; 77 spontaneous ventral hernias and 73 incisional hernias) who were treated by open overlay technique using polypropylene mesh. Sociodemographic characteristics, associated factors; (hard labor occupations, chronic cough, diabetes mellitus, smoking, body mass index, hernia characteristics, intraoperative and post-operative data were collected. Patients were followed for one year postoperatively to assess the post-operative complication.

Results: There were 150 patients; of them, spontaneous hernia formed (51.4%) and (48.6%) incisional hernia. The mean age was 56.2±13.60 years for patients with spontaneous hernia, and 38.4±12.70years for incisional hernia distributed as 27.3% males and 72.7% females, with 2.7:1 female to male ratio in spontaneous hernia. For incisional hernia; there were 75.3% males and 24.7% females with 3.1:1 male to female ratio. Distribution of major associated clinical factors were; 21.3% for hard labor, 15.3% for diabetes mellitus, and 12% for constipation. Obesity was noted in 16.7% of patients.  The operation time was almost similar in both types of hernia; 50.6 ±28.40 minutes vs. 53.2 ±28.10 minutes in spontaneous and incisional hernia respectively. The main duration of post-operative drain placement was 5.6±1.10 days in incisional hernia and 4.1±1.00 days for spontaneous hernia whereas post-operative hospital stay was 3.0±1.70 days for spontaneous hernia, and 5.4 ±1.90 days for incisional hernia. The overall post-operative morbidity developed in 40 patients; 23.4% in spontaneous hernia and 30% in incisional hernia, with no deaths. The post-operative complications in spontaneous hernia were; hematoma (6.5%), skin necrosis and chronic pain 5.2% for each, and 3.9% for seroma. In incisional hernia, the complications were; seroma 12.3%, chronic pain 8.2%. While, hematoma, and skin necrosis 2.7%.

Conclusion: The study identified several associated factors that had significant association to hernia in these patients. These mostly were smoking, and hard lobar occupation. However, prevalence of obesity was lower than global reports. Overlay hernioplasty repair was found to be safe, technically simple and effective approach, associated with low incidence and mild postoperative complications and without deaths.

Keywords: Ventral hernia, Abdominal hernia, Hernia repair, Hernioplasty, Mesh repair, Overlay, Onlay.

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