Incisional Hernia Following Laparotomy among Women in Enugu, Nigeria: A Ten-year Review
An incisional hernia
may occur in women following laparotomy. Obesity has become an increasing non-communicable
public health problem in middle and low-income countries. Also, the caesarean section
has been on the increase even among obese women. The study aimed to evaluate the
outcome of care and determine the association between caesarean section and obesity
in the development of incisional hernias among women who underwent laparotomy for
various indications in Enugu, Nigeria. A retrospective
study of women who underwent incisional hernia repair between January 2010 and December
2020 at the 2 tertiary hospitals in Enugu, Nigeria, was carried out. The following
parameters were assessed; age, predisposing factors, presence and absence of obesity
and the class of obesity, comorbidity, presenting symptoms, duration of symptoms
before presentation, the interval between presentation and intervention, intra-operative
finding, the definitive operative procedure performed, complications of treatment,
and outcome of treatment. A total of 46 patients were evaluated. Their mean age
was 44 years. Caesarean section and obesity
were the most frequently performed laparotomy (31/46, 67.5%) and most common comorbidity
(41/46, 89.2%) respectively among the participants. The majority of the patients
(44/46, 95.7%) had mesh repair of the incisional hernia, and most had no post-operative
complications. There was no significant relationship between incisional hernia and
obesity, p = 0.446. There was no mortality. In
section, a frequently performed laparotomy, and obesity as comorbidity were frequently
associated with the occurrence of incisional hernia among the participants. The
use of appropriate mesh and techniques were associated with good results and reduced
 Muysoms FE, Miserez M, Berrevoet
F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional
abdominal wall hernias. Hernia [Internet]. 2009 [cited 2021 Oct 27];13(4):407. Available
 Shand AW, Chen JS, Schnitzler
M, Roberts CL. Incisional hernia repair after caesarean section: a population-based
study. Aust New Zeal J Obstet Gynaecol. 2015 Apr;55(2):170–5.
 Paulsen CB, Zetner D, Rosenberg
J. Incisional hernia after cesarean section: A systematic review. Vol. 244, European
Journal of Obstetrics and Gynecology and Reproductive Biology. Elsevier Ireland
Ltd; 2020. p. 128–33.
 Ajlouni MA. The Incidence and
Risk Factors of Incisional Hernia in Post Caesarean Sections. Middle East J Intern
Med. 2013 Mar;6(2):9–12.
 Sanders DL, Kingsnorth AN. The
modern management of incisional hernias. Vol. 344, BMJ (Online). 2012.
 Anaya DA, Dellinger EP. The obese
surgical patient: A susceptible host for infection. Surg Infect (Larchmt). 2006
 Al-Dahamsheh H. Incisional Hernia
of Elective Midline Caesarean Section: Incidence and Risk Factors. Vol. 25, Bangladesh
J Obstet Gynaecol. 2010.
 Yatsuya H, Li Y, Hilawe EH, Ota
A, Wang C, Chiang C, et al. Global trend in overweight and obesity and its association
with cardiovascular disease incidence. Vol. 78, Circulation Journal. Japanese
Circulation Society; 2014. p. 2807–18.
 Kelly T, Yang W, Chen CS, Reynolds
K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes.
 Anzaku AS. Prevalence and Risk
Factors for Obesity in a Nigerian Obstetric Population. Am J Heal Res. 2014;2(5):229.
 Anzaku A, Idikwu O, Emmanuel
O, Kingsley O. Impacts of Obesity on Maternal and Fetal Outcomes in Women with Singleton
Pregnancy at a Nigerian Clinical Setting. Br J Med Med Res. 2015;6(12):1159–65.
 Chigbu C, Aja L. Obesity in pregnancy
in southeast Nigeria. Ann Med Health Sci Res. 2011;1(2):135–13540.
 Ezeanochie MC, Ande AB, Olagbuji
BN. Maternal obesity in early pregnancy and subsequent pregnancy outcome in a Nigerian
population. Afr J Reprod Health. 2011;15(4):55–9.
 Ramsey, P. S Schenken RS. Obesity
in pregnancy: Complications and maternal management. Up To Date. 2019;1–40.
 Okafor II. Indications for Caesarean
Delivery in a State University Teaching Hospital, Enugu, Southeast, Nigeria. Int
J Nurs Healthc. 2015;1(1):16–21.
 Betrán AP, Ye J, Moller A-B,
Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates:
Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):
 Betran AP, Torloni MR, Zhang
JJ, Gülmezoglu A, Zongo A. WHO Statement on Caesarean Section Rates. BJOG. 2016;
 Tipton AM, Cohen SA, Chelmow
D. Wound infection in the obese pregnant woman. Vol. 35, Seminars in Perinatology.
W.B. Saunders; 2011. p. 345–9.
 Kadia BM, Chichom-Mefire A, Halle-Ekane
GE. Exploring the role of obesity and overweight in predicting the post-operative
outcome of abdominal surgery in a sub-Saharan African setting: a prospective cohort
study. BMC Res Notes. 2018 Dec;11(1):742.
 Thornburg LL. Antepartum obstetrical
complications associated with obesity. Vol. 35, Seminars in Perinatology. 2011.
 Tan T, Sia AT. Anaesthesia considerations
in the obese gravida. Vol. 35, Seminars in Perinatology. 2011. p. 350–5.
 Cleveland RD, Zitsch RP, Laws
HL. Incisional hernia in morbidly obese patients. The American Surgeon. 1989; 55(1):
 Sauerland S, Korenkov M, Kleinen
T, Arndt M, Paul A. Obesity is a risk factor for recurrence after incisional hernia
repair. Hernia. 2004; 8(1): 42-46.
 Gunatilake RP, Perlow JH. Obesity
and pregnancy: Clinical management of the obese gravida. Vol. 204, American Journal
of Obstetrics and Gynecology. 2011. p. 106–19.
 WALL P. Vertical skin incisions
and wound complications in the obese parturient. Obstet Gynecol. 2003 Nov;102(5):952–6.
 Ceydeli A, Rucinski J, Wise L.
Finding the best abdominal closure: An evidence-based review of the literature.
Curr Surg. 2005;62(2):220–5.
 Walton RB, Shnaekel KL, Ounpraseuth ST, Napolitano PG, Magann EF. High transverse skin incisions may reduce wound complications in obese women having cesarean sections: a pilot study. J Matern Neonatal Med. 2019 Mar;32(5):781–5.
 Aabakke AJM, Krebs L, Ladelund S, Secher NJ. Incidence of incisional hernia after cesarean delivery: A register-based cohort study. PLoS One. 2014 Sep;9(9).
 Ayandipo OO, Afuwape OO, Irabor DO, Abdurrazzaaq AI. Adult Abdominal Wall Hernia in Ibadan. Ann Ibadan Postgrad Med [Internet]. 2015;13(2):94–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27162521%0A & http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4853882.