Postoperative-treatment following open incisional hernia repair: A survey and a review of literature

Abstract

Introduction: Incisional hernias of the abdominal wall are frequent complication after laparotomy (9-20%). Open incisional hernia repair with sublay mesh placement (SMP) on the posterior rectus sheath is described as being a sufficient method for repairing incisional hernia. In order to ensure wound healing and to therefore prevent recurrence, carrying an abdominal binder (AB) or a pressure dressing (PD) and physical rest for a certain time is the common postoperative recommendation, though the evidence for post-operative treatment is low. Hence, we conducted a survey to reveal the different recommendations given by surgical departments (SD).

Methods: We conducted a survey among 65 German SDs of the XXX Hospital Group. The SDs were interviewed about the number of open incisional hernia repair with SMP in the time frame of 2013-2014, the known recurrence rate (RR), their recommended prescription of the AB/PD and the time of physical rest.

Results: The head physicians of 48 surgical departments answered the questionnaire. The survey revealed 42 different recommendations of postoperative-treatment. The majority of the SDs advices 4 weeks (20,5%) of physical rest and no prescription of the AB (29,5%). No correlation between the known RR and the duration of physical rest was detected. No head physician's prescribes a PD.

Conclusions: Due to our findings we assume that a short period of physical rest is a considerable postoperative treatment following an open incisional hernia repair with SMP. By reducing the individual incapacity for work and immobility this would have a social-economic impact. The use of a PD may prevent seroma formation. Further investigations with randomized clinical trials are mandatory to support our hypothesis.

Keywords: Abdominal binder; Open incisional hernia repair; Pressure dressing; Return to work; Sublay mesh placement; Survey; physical rest.