title: Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh.
abstract: BACKGROUND
  Incisional hernia is a serious complication of abdominal surgery. We compared incisional hernia frequency following gastric bypass (GBP) for morbid obesity versus total abdominal colectomy and ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. A prefascial polypropylene mesh repair was also evaluated.
  
  
  METHODS
  All patients had midline incisions, xiphoid to umbilicus in GBP patients and midepigastrium to pubis in IPAA patients. Fascia were closed with running No. 2 polyglycolic acid suture. Ninety-eight patients underwent prefascial polypropylene mesh repair; 80 were GBP patients, 46 had 1 previous repair, and 17 had 2 to 9 previous repairs (6 with properitoneal mesh).
  
  
  RESULTS
  Incisional hernia occurred in 20% (198/968) of GBP patients (19% without versus 41% with a previous hernia, P < 0.001) versus 4% (7/171) of the IPAA patients (P < 0.001), of whom 102 (60%) were taking prednisone (32 +/- 2 mg/d) and 5 were quite obese (body mass index > or = 30 kg/m2). Additional risk factors for hernia in GBP patients included wound infection, diabetes, sleep apnea, and obesity hypoventilation. For the 98 patients who underwent prefascial polypropylene mesh repair, the mean follow-up was 20 +/- 2 months (range 6 to 104), and complications occurred in 35% of patients, including minor wound infection (12%), major wound infection (5%), seroma (5%), hematoma (3%), chronic pain (6%), and recurrent hernia (4%).
  
  
  CONCLUSIONS
  Severe obesity is a greater risk factor for incisional hernia and hernia recurrence than chronic steroid use in nonobese colitis patients. A prefascial polypropylene mesh repair minimizes recurrence.
authors.affiliation: Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
authors.forename: H J
authors.initials: HJ
authors.lastname: Sugerman
authors.forename: J M
authors.initials: JM
authors.lastname: Kellum
authors.forename: H D
authors.initials: HD
authors.lastname: Reines
authors.forename: E J
authors.initials: EJ
authors.lastname: DeMaria
authors.forename: H H
authors.initials: HH
authors.lastname: Newsome
authors.forename: J W
authors.initials: JW
authors.lastname: Lowry
mesh_terms: D000005:Abdomen / Q000601:surgery*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery; D005205:Fascia; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006555:Hernia, Ventral / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011126:Polypropylenes; D011183:Postoperative Complications; D011241:Prednisone / Q000009:adverse effects*; D016737:Proctocolectomy, Restorative; D012008:Recurrence; D019966:Substance-Related Disorders / Q000150:complications*; D013526:Surgical Mesh
chemical_list: D011126:Polypropylenes; D011241:Prednisone