The burden of incisional hernia in necrotizing pancreatitis: how can we improve?

Al-Azzawi, Hayder H.; Kuhlenschmidt, Heidi; Howard, Thomas J.; Bermes, Angela M.; Bishop, Sarah N.; Nakeeb, Attila; Selzer, Don J.; Lillemoe, Keith D.; Zyromski, Nicholas J.

doi:10.1016/j.amjsurg.2009.08.039

« Previous Next »The American Journal of Surgery
Volume 199, Issue 3 , Pages 310-314, March 2010

The burden of incisional hernia in necrotizing pancreatitis: how can we improve?

Presented at the 2009 Midwest Surgical Association (MSA) annual meeting, August 2–5, 2009, Lake Geneva, WI.

Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

Received 27 July 2009; received in revised form 13 August 2009

Abstract

Background

Necrotizing pancreatitis (NP) patients frequently require pancreatic debridement, and have risk factors for incisional hernia (IH). However, no published data exist regarding the incidence of IH in NP. The aim of the current study was to define the incidence of and identify risk factors for developing IH after pancreatic debridement.

Methods

Hernia presence was determined by clinical examination and patient interview. Technical and clinical considerations were noted: type of incision, closure, suture material, age, body mass index (BMI), diabetes mellitus (DM), preoperative albumin, and number of operations.

Results

Sixty-three (42%) of 149 debrided patients with NP developed IH. IH patients were older (P < .05). No differences in surgical technique or clinical risk factors were seen between groups.

Conclusion

The incidence of IH in NP patients requiring operative debridement is substantially higher than that in patients undergoing routine laparotomy. Innovative fascial closure techniques such as primary fascial buttress with nonsynthetic mesh should be considered.

Keywords: Incisional hernia, Ventral hernia, Risk factors, Necrotizing pancreatitis, Pancreatic debridement