Retrospektive Analyse der Narbenhernieninzidenz nach 2983 Laparotomien in der Chirurgischen Universitätsklinik der RWTH Aachen über einen Zeitraum von 10 Jahren (1.1.1986 - 31.12.1995)
The incisional hernia is the most often seen complication of operations in abdominal surgery. Many pre-, intra-, and post-operative factors are responsible for the development of the incisional hernia. An analysis of these factors and their influences gives us more insight into the pathogenesis of this disorder. This in turn would contribute to a reduction of the incidence of this economically very important complication of abdominal surgery. This dissertation is a retrospective analysis of data of 2983 patients for incisional hernia after laparotomy. The average observation period was 21.14 Months (SD = 26.97). For the observation period, an incidence of 4,3 % was seen. Using the Kaplan-Meier method for a period of 10 years, an incidence of 18,7 % could be estimated. The uni-variate analysis method (chi-square -Test) showed the following factors to be significant contributor to the development of incisional hernias: Gender, Age, Re-incision, Pre-operations, Anaemia and the presence of malignant disease. Furthermore, postoperative therapy with catecholamines, contamination of the wound and other disturbances of wound healing were shown to play a significant role in the development of incisional hernias. Assessment the influence of individual factors on abdominal wound healing is a difficult issue. None of the factors can easily be considered alone, because the development of incisional hernia underlies multifactorial influences. In literature, all the factors are valued unidentically in this respect. Studies mentioned in literature vary much with respect to the observation period, the number of observed patients and the used statistical methods. Comparing results of these studies is definitely not possible. In an attempt to uncover the interaction of the various risk factor for the development of incisional hernias, acquired data was also analysed with the aid of a multivariate analysis method: the binary logistic regression. Hereby, the following factors showed a statistically significant effect on the development of incisional hernia: the Body Mass Index (BMI), Gender, Re-incision, Malignancy, the Surgeon and wound contamination (Table 17). In spite of the complexity of processes leading to the development of incisional hernia, one can say, the observation of simple and cheap principles like the prevention of wound contamination during abdominal surgery, is capable of reducing the incidence of incisional hernias. For this purpose, various systems, which can effectively reduce the rate of wound contamination, are offered in the market of today. These systems however must still prove their advantage over hitherto systems in the context of “evidence based medicine”. Moreover, the use of retractors on the wound edges remains an unevaluated factor of unknown consequence. There exists a necessity to analyse those risk factors, which can easily be modified in order to be able to optimise them. In the first place, one has to think of the modification of techniques and materials used in abdominal wound closure. This dissertation shows the influence of various exogenous and endogenous factors on the development of incisional hernia. In order to reduce the incidence of incisional hernia, we do not only need to master the theory, but to convey theoretical knowledge into our daily practice. In order to enhance this process, there is need for continues exchange of gained knowledge and ideas among surgeons. Key words: Incisional hernia, wound healing, laparotomy closure, risk factors.
info:eu-repo/classification/ddc/610, Medizin, Narbenhernie, Wundheilung, Laparotomieverschluß, Risikofaktoren
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