title: Incisional hernia in the elderly: risk factors and clinical considerations.
abstract: OBJECTIVE
  Ventral incisional hernia is a common complication of abdominal surgery. The marked improvements in medical technology and healthcare, lead to an increasing number of elderly patients to take advantage of even complex surgical procedures. The objective of this literature review was to analyze the risk factors for ventral incisional hernia in elderly patients and to identify measures that might decrease the incidence of this complication.
  
  
  METHODS
  An analysis of the surgical literature was performed using the search engines EMBASE, Cochrane Library, and PubMed with particular reference to elderly patients using the keywords: abdominal hernia, wound dehiscence, incisional hernia, incidence, trocar site hernia, and hernia prevention.
  
  
  RESULTS
  In our opinion the risk factors for incisional hernia should be separately considered. First those related to the patients and to the abdominal surgery and, in addition, those related to the surgery of the abdominal wall defects.
  
  
  CONCLUSIONS
  Reparative surgery of the abdominal wall, to date uniquely characterized by the use of the mesh, should be considered an additional risk factor for the occurrence of incisional hernia. However, the low incarceration risk, the risk of recurrence, the relevant rate of postoperative pain and discomfort and complications associated with mesh repair, as small bowel obstruction, mesh infection, and entero-cutaneous fistula, suggest that the general indication for surgical treatment of incisional hernias, in a symptomatic or oligosymptomatic elderly patients, should be critically reconsidered in order to avoid unnecessary surgery.
authors.affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Italy. Electronic address: cagliapi@unict.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Caglià
authors.affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Italy. Electronic address: traciang@unict.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Tracia
authors.affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Italy. Electronic address: la.borzi@yahoo.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Borzì
authors.affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Italy. Electronic address: amodeo@unict.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Amodeo
authors.affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Italy. Electronic address: traciang@unict.it.
authors.forename: Lucio
authors.initials: L
authors.lastname: Tracia
authors.affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Italy. Electronic address: veroux@unict.it.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Veroux
authors.affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Italy. Electronic address: amodeo@unict.it.
authors.forename: Corrado
authors.initials: C
authors.lastname: Amodeo
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D006555:Hernia, Ventral / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012008:Recurrence; D012307:Risk Factors; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control
keywords: Elderly patients; Incisional hernia; Risk factors