GREATER RISK OF INCISIONAL HERNIA WITH MORBIDLY OBESE THAN STEROID-DEPENDENT PATIENTS AND LOW RECURRENCE WITH PREFASCIAL POLYPROPYLENE MESH

BACKGROUND: Incisional hernia is a serious complication of abdominal s urgery. We compared incisional hernia frequency following gastric bypa ss (GBP) for morbid obesity versus total abdominal colectomy and ileal pouch-anal anastomosis (IPAA) for ulcerative colitis, A prefascial po lypropylene mesh repair was also evaluated. PATIENTS AND METHODS: All patients had midline incisions, xiphoid to umbilicus in GBP patients a nd mldeplgastrium to pubis in IPAA patients. Fascia were closed with r unning 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 properiton eal mesh). RESULTS: Incisional hernia occurred in 20% (198/968) of GBP patients (19% without versus 41% with a previous hernia, P < 0.001) v ersus 4% (7/171) of the IPAA patients (P < 0.001), of whom 102 (60%) w ere taking prednisone (32 +/- 2 mg/d) and 5 were quite obese (body mas s index greater than or equal to 30 kg/m(2)). Additional risk factors for hernia in GBP patients included wound infection, diabetes, sleep a pnea, and obesity hypoventilation, For the 98 patients who underwent p refascial polypropylene mesh repair, the mean follow-up was 20 +/- 2 m onths (range 6 to 104), and complications occurred in 35% of patients, including minor wound infection (12%), major wound infection (5%), se roma (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 coli tis patients. A prefascial polypropylene mesh repair minimizes recurre nce.