title: Repair of large and giant incisional hernia with onlay mesh: perspective of a tertiary care hospital of a developing country.
abstract: OBJECTIVE
  Ventral incisional hernias, especially large and giant, carry significant post repair complications. This retrospective review is undertaken to determine the outcomes of large and giant incisional hernia repair as well as the risk factors of recurrence and surgical site infection at a tertiary care hospital in developing country.
  
  
  METHODS
  This case series included adult patients, operated between January 2001 and June 2009 for incisional hernia of size ≥ 10 cm (vertical or horizontal dimension) at our institute with follow up of at least one year. The charts of selected patients were reviewed by a general surgery fellow for hernia recurrence, complications, mortality and the predictive factors.
  
  
  RESULTS
  Sixty out of 391 patients operated for incisional hernia were found eligible; of them 29 (48.3%) had large (defect of 10-15 cm) and 31 (51.7%) had giant hernia (defect size >15 cm). Mean age of patients was 43.8 ± 11.8 with female preponderance (male: female; 1:1.6). Fourteen (23.33%) patients developed complications and there was no mortality. Surgical Site Infection (SSI) was observed in 13 (21.67%) patients and significant predisposing factors for SSI (with or without mesh infection) were diabetes mellitus, emergency surgery, contaminated surgery and recurrent incisional hernia. With a mean follow up of 20.05 ± 8.8 months (range: 12-48 months), four (6.67%) patients had recurrence of hernia.
  
  
  CONCLUSIONS
  Repair of large and giant incisional hernia using prosthetic non-absorbable mesh, mainly onlay, carry acceptable rates of complications.
authors.affiliation: Dow University of Health Sciences (OJHA Campus), Gulistan-e-Johar, Karachi, Pakistan. memonayaz2002@yahoo.com
authors.forename: Ayaz Ahmad
authors.initials: AA
authors.lastname: Memon
authors.forename: Aimal
authors.initials: A
authors.lastname: Khan
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
authors.forename: Ghulam
authors.initials: G
authors.lastname: Murtaza
authors.forename: Masooma
authors.initials: M
authors.lastname: Zaidi
mesh_terms: D000328:Adult; D003906:Developing Countries; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000209:etiology; D062606:Tertiary Care Centers