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P060: INCISIONAL HERNIA REPAIR AT AN UNIVERSITY HOSPITAL IN SOUTH BRAZIL: PROSPECTIVE COHORT STUDY
Thamyres Zanirati Dos Santos, MD; Henrique Rasia Bosi, MD; Eduardo Martins, MD; Bruno Sliprandi Pinto, MD; Leandro Totti Cavazzola, MD, MChir, PhD, FACS; Hospital De Clínicas De Porto Alegre
Incisional hernias (IH) are about 10% of all hernia repairs. Obesity and wound infection are the most associated comorbidities related to increased risk of incisional hernia. Proper technique, position of the mesh and the role of minimally invasive repair are still debatable. Our main aim was to understand our epidemiologic profile in a public hospital in a developing country. Our secondary goal was to evaluate differences between onlay and retromuscular repair in this population.
Methods: Prospective cohort of patients who underwent incisional hernia repair between January 2019 to January 2020 in a tertiary university hospital in south Brazil funded by public health system (SUS). Choice of mesh position and technique was based on clinical judgement by the surgeon and were not influenced by this study. Exclusion criteria were: age less than 14 years old, primary ventral hernias, repair without mesh, patients without at least one follow-up appointment at this center or with other surgical procedures performed at the time of the index operation. Data were analysed with IBM® SPSS® Statistics 23.0. We used Chi-Square for dichotomous variables, and t Student and Mann-Whitney test for continuous ones.
Results: During our study period 114 patients with incisional hernia were operated. 31 were excluded (22 not founded by SUS, 1 without mesh and 8 with combined procedure). Most patients were females (66,3%), with an average of 60,2 years old, a BMI less than 30 Kg/m² in 52%. Regarding comorbidities, ASA II was the most common finding (69,6%), along with hypertension (57,8%). Most common surgeries that lead to incisional hernia were exploratory laparotomy, colectomy or cholecystectomy (open or lap) (58%). The majority of hernias occurred at midline, with epigastric site being the most frequent (34%). Regarding technique, most of repairs were retromuscular (48), with 35 onlay repairs in these series. There were no differences between two groups (onlay vs. retromuscular) regarding mesh or suture material, mesh fixation or dimensions, urgency vs. elective procedure, associated fistula, previous hernioplasty, open vs. lap. The only difference between two groups was the use of drains, which was more common in the retromuscular technique (48x35%, p<0,001). There were no differences regarding postoperative complications (infection, seroma, pain at first appointment, fistula, wound dehiscence or death) or recurrence at follow up. Also there were no differences between infected vs. not infected with the same repair technique regarding age, BMI, mesh or hernia dimensions.
Conclusion: Our profile correlates with other reports in the literature for this setting of patients. In this prospective cohort in our hospital no difference were found between onlay and sublay regarding postoperative complications and recurrence. Long term follow up is on its way to evaluate this patients over time.
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