Anterior abdominal wall hernia in adults - Clinical studies on treatment and prevention

Abstract

Abdominal wall hernia is a major health burden, especially as secondary to surgical therapy. Incisional hernia occurs in 10- 20 % of laparotomy scars and parastomal hernia occurs in more than 50% of patients with end colostomy. Parastomal hernia repair has a high failure rate. Modern hernia repair includes the use of tissue support with mesh, but in some patient categories this is still circumvented in fear of mesh infection, e.g. potentially contaminated wounds and immunosuppressed patients - and in small spontaneous hernia. Mesh in incisional hernia prophylaxis is a novel concept and not widely implemented. In this thesis the aims were to assess the efficacy of laparoscopic hernia repair and compare the results of an incisional hernia cohort to a spontaneous hernia cohort as well as a cohort with incisional hernia after liver or kidney transplantation. Additionally, to assess the efficacy of parastomal hernia prevention by synthetic mesh prophylaxis in end colostomy creation. The laparoscopic repair of abdominal wall hernia with implantation of a synthetic intraperitoneal mesh was safe and effective in all patient categories. In immunosuppressed patients the risk of wound and mesh infection is very minor in contrast to the open repair method. The hernia recurrence rate was higher (10%)in the transplanted cohort that also had the largest hernias. The use of absorbable suture to close the defect before mesh reinforcement – as opposed to bridging the defect – did not improve outcomes. Implantation of a synthetic mesh at the stoma site in end colostomy creation more than halved the risk of parastomal hernia (hazard ratio 0.09; confidence interval 0.02-0.44). The aperture in the abdominal wall is stabile when using mesh protection compared to a significant enlargement in non-protected apertures. Mesh implantation did not affect adverse events. Laparoscopic repair of incisional hernia in transplanted patients is favorable and use of mesh in stoma creation prevents hernia.