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


CONCLUSIONS
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.
Al-Azzawi
Hayder H
HH
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Kuhlenschmidt
Heidi
H
Howard
Thomas J
TJ
Bermes
Angela M
AM
Bishop
Sarah N
SN
Nakeeb
Attila
A
Selzer
Don J
DJ
Lillemoe
Keith D
KD
Zyromski
Nicholas J
NJ
D005260:Female; D006555:Hernia, Ventral / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors