Incisional hernia is defined as a hernia that develops through a previously made surgical incision in the abdominal wall, typically occurring at the site of fascial weakness following laparotomy [1]. It is one of the most common complications of abdominal surgery, with reported incidence ranging from 10% to 20% depending on the type of surgery, patient-related factors, and surgical technique employed [2,3].

Several risk factors have been identified for the development of incisional hernias, including patient-related factors such as advanced age, obesity, chronic cough, diabetes mellitus, and poor nutritional status, as well as surgery-related factors such as emergency surgery, wound infection, poor closure technique, and postoperative complications [4,5]. Women are reported to have a higher incidence due to a higher frequency of gynecological and obstetric abdominal surgeries [6].

Clinically, patients may present with an asymptomatic swelling, pain at the surgical site, or complications such as obstruction or strangulation. The diagnosis is primarily clinical, supported by imaging modalities like ultrasonography and computed tomography in complex or recurrent cases [7].

Surgical repair remains the definitive management of incisional hernias, with techniques including anatomical repair and various mesh-based approaches. Mesh repair, particularly with onlay, sublay, inlay, and intraperitoneal onlay mesh (IPOM) positioning, has shown lower recurrence rates compared to primary suture repair [8,9]. However, postoperative complications such as wound infection, seroma formation, and chronic pain remain concerns [10].

Understanding the epidemiology, risk factors, and management outcomes of incisional hernias in specific populations is crucial for improving surgical strategies and reducing morbidity. This study aims to evaluate the clinical profile, precipitating factors, and surgical outcomes of patients presenting with incisional hernias at the Railway Hospital, Lallaguda, Secunderabad, South Central Railways.

MATERIAL AND METHODS

Study Site

The study was conducted in the Department of General Surgery at Railway Hospital, Lallaguda, Secunderabad, South Central Railways.

Study Population

The study will include all patients aged 18 years or older presenting with an incisional hernia who are giving consent at Railway Hospital, Lallaguda General Surgery Department & Emergency.

Study Design

This is a hospital-based cross-sectional study designed to evaluate the clinical profile, precipitating factors, and management outcomes of incisional hernias.

Sample Size

Calculated using the below formula

N= 4pq/d² P–Prevalence q = 100-p

d = Absolute/Relative precision Calculating N=72 rounding off N=80

Study Duration

The study was conducted from 06.05.2023 to 06.11.2024(18 months)

Inclusion Criteria

• Patients aged more than 18years with incisional hernia.
• Both male and female patients.
• Patients are willing to provide informed consent.

Exclusion Criteria

• Patients who are not willing to provide informed consent.

• Recurrent Incisional Hernia
• Incisional hernia associated with another abdominal hernia.

Clinical Examination

A thorough general physical examination was conducted.

 Detailed abdominal examination to assess the hernia site, size, reducibility, and complications (e.g., obstruction or strangulation).

Investigations

Routine laboratory investigations will include:

Complete blood count (CBC), blood sugar, liver and renal function tests, ECG, serum electrolytes, viral markers, clotting and bleeding time when planning for surgery.

Imaging studies:

Ultrasound of the abdomen and pelvis: To evaluate the contents of the hernial sac and any evidence of obstruction or complications, and CT whole abdomen in complex hernias. Chest X-ray when planning for surgery.

Management Plan

Based on clinical findings and imaging results, a management plan was formulated for each patient.

Surgical interventions and outcomes were recorded as part of the study.

Outcome Measures

Incidence and clinical profile of incisional hernias. Common etiological and precipitating factors.

Management approaches and outcomes, including recurrence and complications

RESULTS AND OBSERVATIONS

TABLE1– DISTRIBUTION OF PATIENTS ACCORDING TO AGE(N=80)

TABLE2– DISTRIBUTION OF PATIENTS ACCORDING TO SEX(N=80)

TABLE 3: DISTRIBUTION OF THE PATIENTS BASED ON TYPE OF PREVIOUS SURGERY(N=80)

Figure 1  Distribution Of Patients According To Predisposing Factors(N=80

TABLE 4: DISTRIBUTION OF PATIENTS ACCORDING TO MODE OF PRESENTATION

Figure 2 Distribution Of The Patients According To Size Of Defect(N=80)

TABLE; 5  –DISTRIBUTION OF PATIENTS ACCORDING TO PREVIOUS SURGERIES (N=80)

Figure3 Distribution Of Patients According To Previous IncisionsUsed(N=80)

TABLE; 6 -TYPE OF HEALING DISTRIBUTION OF PATIENTS IN PREVIOUS SURGERY (N=80)

TABLE; 7 NO OF PREVIOUS ABDOMINALSURGERIES(N=80)

TABLE 8 DISTRIBUTION OF PATIENTS ACCORDING TO TYPE OF REPAIR IN PRESENT SURGERY(N=80)

Figure; 4 Type Of Present Surgery(N=80)

TABLE; 9 TYPE OF MESH POSITIONING(N=80)

Figure; 5 Post-Operative Complications In Present Surgery(N=80)

DISCUSSION

Incisional hernia is a frequent complication of abdominal surgery, arising due to weakness in the abdominal wall at the site of a previous incision. The incidence varies depending on patient factors, type of surgery, and wound healing, with reported rates ranging from 10–20% following laparotomy [1,2]. Understanding patient characteristics, surgical factors, and repair outcomes is essential to optimize management.

In the present study, the majority of patients were in the 51–60 years age group (32.5%), followed by 41–50 years (22.5%). This reflects the increased risk of hernia formation with advancing age, likely due to reduced collagen quality, impaired tissue healing, and comorbidities such as diabetes or chronic cough [3,4].

Females constituted 71% of the cohort, with males representing 29%. This is consistent with literature reporting higher incidence in women, attributed to a greater frequency of gynecological and obstetric surgeries, which were the most common previous procedures in this study. Hysterectomy (36.25%) and cesarean section (18.75%) were leading contributors, followed by tubectomy (16.25%) and laparotomy (12.5%). Emergency surgeries accounted for 30%, while elective surgeries comprised 70%, emphasizing that both urgent and planned surgeries can predispose to incisional hernia [5,6].

The study also highlighted the importance of wound healing. Primary healing was observed in 77.5% of patients, while 22.5% had secondary healing. Poor healing, along with multiple prior surgeries, increases the likelihood of hernia formation. Most patients had only one prior surgery (65%), but 30% had two, and 5% had more than two, confirming the cumulative risk associated with repeated abdominal operations [7,8].

Predisposing factors identified included wound infection, obesity, advanced age, and repeated surgeries. Swelling was the most common mode of presentation (47.5%), followed by swelling with pain (20%) and isolated pain (15%). Gastrointestinal symptoms such as nausea, vomiting, and constipation were less common, reflecting that most hernias were uncomplicated at presentation [9].

Surgical management predominantly involved mesh repair (86.25%), with anatomical repair performed in 13.75% of patients. Mesh placement was mostly onlay (59.4%), followed by intraperitoneal onlay mesh (IPOM) (20.2%), sublay (15%), and inlay (2.89%). The high proportion of mesh repairs reflects current best practices, as mesh significantly reduces recurrence compared to primary suture repair [10,11]. Anatomical repair was limited to small defects or cases where mesh was contraindicated.

Postoperative complications were observed in a small proportion of patients, consistent with the literature emphasizing that careful surgical technique and appropriate mesh positioning minimize morbidity. Onlay mesh, while technically easier, carries a slightly higher risk of seroma formation, whereas sublay placement is associated with lower recurrence [12,13].

This study reinforces known risk factors for incisional hernia, including female sex, age above 50 years, previous abdominal surgeries, poor wound healing, and emergency surgery. It also demonstrates the effectiveness of mesh repair as the standard surgical approach, with a preference for onlay or sublay placement based on defect characteristics and patient factors.

CONCLUSION

Incisional hernias are a common postoperative complication, particularly in patients above 50 years of age and in females, largely due to prior gynecological and obstetric surgeries. The risk is further increased by factors such as poor wound healing, multiple previous abdominal surgeries, and emergency procedures.

Clinical presentation is most often swelling at the surgical site, with pain and gastrointestinal symptoms being less common. Mesh repair, particularly onlay and sublay techniques, is the preferred surgical approach due to lower recurrence rates and favorable outcomes compared to anatomical repair.

Careful patient assessment, optimization of predisposing factors, and appropriate surgical technique are essential to minimize postoperative complications and recurrence. This study reinforces the importance of early recognition, risk factor management, and the use of mesh repair as the standard of care in incisional hernia management.

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