A comparative study between anatomical vs mesh repair of incisional hernia

Background: Incisional hernia is a very common problem encountered by surgeons and represent a serious complication of abdominal surgery. The exact incidence of incisional hernia has not been well defined, although reported incidence suggests the possibility between 2-11% following abdominal surgeries. Incisional hernias enlarge over time and can result in serious complications. Various types of repair have been described. Commonly practiced are anatomical and mesh repairs, but the results are disappointing with a high incidence of reported complications and recurrence following various techniques of repair. To evaluate the outcome of anatomical repair (as regards to non affordability of mesh due to its cost by patients) and mesh repair of incisional hernia with reference to technical difficulty, convalescence, wound infection and recurrence. Methods: 50 cases of incisional hernia admitted in the Tertiary Care Hospital, Telangana from March 2019 to February 2020. Study includes all incisional hernias admitted and treated. Results: The majority of patients were in the age group of 41-50 years and more commonly females than males. Most common symptom that patient presented with was swelling in the abdomen usually below umbilicus in the midline (54% cases). 58% patients presented with incisional hernia within 5 years of previous surgery. Duration of surgery varied with each case, average time taken for surgery in anatomical group was 63.8 min and mesh group was 73.8 min. No technical difficulty was encountered in performing both anatomical and mesh repair. All the cases were followed up for a period of 1 year and no recurrence was noted in both the groups within the study period. Conclusion: Based on the evidence from the present and previous studies, the anatomical repair is superior in terms of occurrence of wound infections and other post operative complications with shorter period of convalescence. Whereas mesh repair is superior in terms of recurrence as is evidenced by the previous studies, but the present study is insufficient to know the true recurrence rate due to the shorter period of follow up. Thus, we conclude that anatomical repair in most of the patients can be done without compromising the outcome in the patients who cannot afford mesh and without any underlying factors like obesity, very large and multiple defects and recurrent cases which obviates the need for mesh repair.