INCIDENCE OF ABDOMINAL-WALL HERNIA IN AORTIC-SURGERY

BACKGROUND: True aneurysms of the abdominal aorta and its branches are at least in part due to defects in the structural integrity of the ar terial wall. Whether the defect is isolated to the vascular wall is un clear. If the structural weakness involves other tissues, patients wit h aneurysmal disease should have a higher incidence of collagen and fa scial defects, such as abdominal and inguinal hernias. METHOD: We revi ewed 100 patients who underwent elective aortic reconstruction for ane urysmal or occlusive disease. All patients were operated on by the sam e group of vascular surgeons, through a midline incision, with fascia closed using running absorbable suture. Midline incisional and inguina l hernias were identified, and all patients were followed up for at le ast 1 year. Comparisons between groups were made for established risk factors for ventral hernias. RESULTS: Incisional hernias occured in 18 of 58 (31%) aneurysm patients, compared with 5 of 42 (12%) occlusive disease patients (P = 0.025). Inguinal hernias occurred in 11 of 58 (1 9%) aneurysm patients versus 2 of 42 (5%) occlusive disease patients ( P = 0.037). Risk factors were equally distributed between the two grou ps. Neither the size of the aneurysm nor the presence of an iliac arte ry aneurysm affected the incidence of abdominal wall hernias in the an eurysm patients. CONCLUSION: This study emphasizes the increased incid ence of abdominal wall hernias in patients undergoing aortic surgery f or aneurysm disease compared with aortoiliac occlusive disease. The si ze of the aneurysm and the association of an iliac artery aneurysm did not affect the incidence of hernias among these patients. Genetic and biochemical abnormalities are considered as possible explanations. (C ) 1998 by Excerpta Medica, Inc.