Incisional Hernia Following Laparotomy among Women in Enugu, Nigeria: A Ten-year Review

Download Article

DOI: 10.21522/TIJPH.2013.10.02.Art003

Authors : Enebe Joseph Tochukwu, Iloh Anthony Chukwudi

Abstract:

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 conclusion, caesarean 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 recurrence.

Keywords: Caesarean section, Incisional hernia, Laparotomy, Obesity, Women.

References:

[1] 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 from: https://pmc/articles/PMC2719726/.

[2] 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.

[3] 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.

[4] 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.

[5] Sanders DL, Kingsnorth AN. The modern management of incisional hernias. Vol. 344, BMJ (Online). 2012.

[6] Anaya DA, Dellinger EP. The obese surgical patient: A susceptible host for infection. Surg Infect (Larchmt). 2006 Oct;7(5):473–80.

[7] Al-Dahamsheh H. Incisional Hernia of Elective Midline Caesarean Section: Incidence and Risk Factors. Vol. 25, Bangladesh J Obstet Gynaecol. 2010.

[8] 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.

[9] Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008 Sep;32(9):1431–7.

[10] Anzaku AS. Prevalence and Risk Factors for Obesity in a Nigerian Obstetric Population. Am J Heal Res. 2014;2(5):229.

[11] 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.

[12] Chigbu C, Aja L. Obesity in pregnancy in southeast Nigeria. Ann Med Health Sci Res. 2011;1(2):135–13540.

[13] 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.

[14] Ramsey, P. S Schenken RS. Obesity in pregnancy: Complications and maternal management. Up To Date. 2019;1–40.

[15] Okafor II. Indications for Caesarean Delivery in a State University Teaching Hospital, Enugu, Southeast, Nigeria. Int J Nurs Healthc. 2015;1(1):16–21.

[16] 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): e0148343.

[17] Betran AP, Torloni MR, Zhang JJ, Gülmezoglu A, Zongo A. WHO Statement on Caesarean Section Rates. BJOG. 2016; 123:667–70.

[18] 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.

[19] 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.

[20] Thornburg LL. Antepartum obstetrical complications associated with obesity. Vol. 35, Seminars in Perinatology. 2011. p. 317–23.

[21] Tan T, Sia AT. Anaesthesia considerations in the obese gravida. Vol. 35, Seminars in Perinatology. 2011. p. 350–5.

[22] Cleveland RD, Zitsch RP, Laws HL. Incisional hernia in morbidly obese patients. The American Surgeon. 1989; 55(1): 61-63.

[23] 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.

[24] 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.

[25] WALL P. Vertical skin incisions and wound complications in the obese parturient. Obstet Gynecol. 2003 Nov;102(5):952–6.

[26] 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.

[27] 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.

[28] 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).

[29] 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.