Application of an Incisional Hernia Protocol at the Municipal Public Server Hospital of Sao Paulo, Brazil: A Retrospective Study

Abstract

Background and Aim: Abdominal Incisional Hernias (AIH) are a frequent complication in medium incisions that lead to a decrease in life quality, socioeconomic losses and increased morbidity to those who have it. Self-care cost for patients evolving with AIH can increase from 97% up to 370% in the first 3 years postoperatively. Regarding this, the Digestive System Surgery Service of the Municipal Public Server Hospital’s (HSPM) has created a protocol to deal with this type of patient since 2015, it has been applied up to the present moment. Incisional hernias result from a multifactorial process that includes preoperative factors such as the cessation of smoking, diabetes control, and obesity, such factors affect the proper functioning of the early stages of the healing process. Patient and Method: Retrospective study with registry analysis of medical records and database records created on cloud regarding perioperative information and outcomes of 35 patients with complex incisional hernias treated under the protocol of patient care for incisional hernia on the Municipal Public Server Hospital (Attachment 1) by the Digestive System Surgery Service, between 2015 and 2019. Result: In our analysis of 35 patients operated by the Digestive System Surgery Team in the period from 2015 to 2019, the average of hospital stay was 4.55 days per patient, with a total of 22.857% of complications, from seromas without serious repercussion to a wall infection which demanded debridement and reassessment for cutaneous flap. Onlay meshes were used in 57.14% of the cases, 37.14% were sublay meshes, and in two cases (5.71%) meshes were placed in two different planes, sublay and onlay - sandwich technique. Of these cases, one was a lateral hernia by multiple procedures and the other was caused by a late postoperative of lumbotomy with lateral hernia evolution. There was a recurrence of a patient with a 6.9cm hernia, he underwent two treatment attempts in 2005 and 2010, which also presented recurrence. In our service the patient was treated with the Rives-Stoppa technique. The patient chose not to undergo further treatment. Conclusion: The protocol application to patients with AIH was associated with a recurrence rate of 2.86%, in a universe of patients in which recurrence still remains a feared complication for both the surgeon and the patient. Furthermore, the complications were treated, most of them successfully, with clinical measures, except for a recurrence and a surgical wound infection in which debridement was necessary, adding up to 5.71%.