FACTORS AFFECTING WOUND COMPLICATIONS IN REPAIR OF VENTRAL HERNIAS

Wound-related complications are common after incisional hernia repair. Prophylactic antibiotic use, placement of subcutaneous drains, and te chnical factors such as mesh implantation reportedly influence the inc idence of these complications, Our aim was to study the incidence of w ound complications in incisional hernia repairs and to determine wheth er use of antibiotics, drains, or mesh influence these rates. Two hund red fifty hernias were repaired in 206 patients over a 14-year period. Simple repair was performed in 151 patients while mesh was used in 99 repairs. Mesh repair was used in larger hernias, required longer oper ating time, and had greater blood loss than simple repair. Twenty-eigh t per cent of repairs with mesh were for recurrent hernias compared wi th 14 per cent for simple repair (P <.05). Overall 34 per cent of pati ents had wound-related complications. Chronic obstructive pulmonary di sease, obesity, steroid therapy, and previous wound infection were not associated with increased risk for wound complications, The use of me sh and hernia defect >10 cm were associated with significantly more wo und complications. The incidence of seroma was increased in mesh repai rs (21% vs 7%), as were total wound complications (44% vs 26%; P < 0.0 5), A suprafascial onlay mesh technique resulted in more frequent sero ma formation. Patients undergoing mesh repair were more likely to rece ive antibiotics (91% vs 71%) and have subcutaneous drains placed (57% vs 25%; P < 0.05) compared to simple primary repair. Neither antibioti cs nor drains had an effect an the incidence of wound complications wi thin each group. Overall, wound infections were more frequent when dra ins were placed. We conclude that repair of incisional hernias is asso ciated with substantial risk of wound-related complications, Mesh is u sed for repair of larger and more complex Hernias and is associated wi th increased risk of wound complications, Abnormal fluid collections a re the most frequent problem,but the use of drains does not reduce the incidence of these complications.