The Effects of Operation Technique on Recurrence of Incisional Hernia Repair

Objectives: The selection of incision type, closure type of incision and the suture material are some of the important factors to prevent hernia development. We should aim to perform the best procedure with the best technique to reduce the risk of recurrence. Surgical options include primary repair and open or laparoscopic repair with mesh. Mesh repairs can be performed as onlay, sublay or inlay according to the area where the mesh is to be laid. In this retrospective study, our main goal was to compare the recurrence rates in patients who underwent incisional hernia repair with onlay and inlay mesh techniques.
Methods: This retrospective study included 185 patients who underwent surgery due to incisional hernia in our clinic between January 2012 and October 2017. Patients were divided into two groups according to the technique as Group 1 with onlay mesh repair and Group 2 with inlay mesh repair. The same type of mesh (prolen) was applied to all patients.
Results: There were 121 patients in Group 1 and 64 patients in Group 2. According to data we obtained, 64.3% of the patients were women and the mean age of all patients was 58.4±16.4 years. Postoperative complications (such as seroma-hematoma, surgical site infection, mesh rejection, postoperative ileus) developed in 29.2% (n=54) of the patients. The length of hospital stay was 4.2±3 days in Group 1 and 5.6±5 days in Group 2. The mean follow-up period was 48.6 months (24-93 months), with the recurrence rates of 5.8% (n=7) in Group 1 and 10.9% (n=7) in Group 2, respectively. There was a statistically significant difference between the groups concerning comorbidity, postoperative complications, the length of hospitalization stay and recurrence.
Conclusion: We believe that the onlay technique will be more appropriate than the inlay technique when only prolen mesh is preferred because the recurrence rates are higher in the inlay technique.

Ýnsizyonel Fýtýk Onarýmýnda Operasyon Tekniðinin Nükse Etkisi

Amaç: Fýtýk geliþimini önlemek için insizyon tipinin seçimi, insizyonun kapatýlma þekli ve kullanýlan sütür materyali önemli faktörlerdir. Amacýmýz en az nükse yol açacak en iyi yöntemi, en iyi teknikle uygulamak olmalýdýr. Cerrahi seçenekler arasýnda, primer onarým ve mesh ile açýk veya laparoskopik onarým yer alýr. Meshli onarým meshin tespit edileceði alana göre onlay, sublay veya inlay olarak yapýlabilir.
Bu retrospektif çalýþmada, insizyonel herni nedeniyle onlay veya inlay teknik ile herni tamiri yapýlan hastalarda ki nüks oranýný karþýlaþtýrmayý amaçladýk.
Metod: Ocak 2012- Ekim 2017 tarihleri arasýnda, kliniðimizde insizyonel herni nedeni ile opere ettiðimiz 185 hastanýn çalýþmaya dahil edildiði retrospektif bir çalýþmadýr.
Hastalarý onlay herni tamiri yapýlanlar (Grup 1) ve inlay herni tamiri yapýlanlar (Grup 2) olmak üzere iki gruba ayýrdýk. Her iki grupta da ayný özellikte (prolen) mesh kullanýlmýþtýr.
Bulgular: Grup 1’de 121, Grup 2’de 64 hasta mevcut idi. Verilere göre, hastalarýn %64.3'ü kadýn, tüm hastalarýn yaþ ortalamasý 58.4 ± 16.4 yýldý.
Hastalarýn %29.2’sinde postoperatif komplikasyon (seroma-hematom, cerrahi alan enfeksiyonu, yama rejeksiyonu, postoperatif ileus gibi) geliþti. Hastanede yatýþ süresi Grup 1'de 4,2 ± 3 gün ve Grup 2'de 5,6 ± 5 gündü. Ortalama izlem süresi 48.6 ay (24-93 ay) olup, nüks oranlarý Grup 1'de %5.8 (n: 7) ve Grup 2'de %10.9 (n: 7) idi. Gruplar arasýnda komorbidite, postoperatif komplikasyon, yatýþ süresi ve nüks açýsýndan istatistiksel olarak anlamlý farklýlýk gözlendi.
Sonuç: Biz inanýyoruz ki, eðer sadece prolen mesh kullanýyorsak, onlay teknik inlay tekniðe göre daha uygun olacaktýr, çünkü inlay teknik de nüks oraný daha yüksektir. (SETB-2019-10-131)