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Ibnosina J Med BS
ARTICLE
Abstract
The precise incidence of incisional hernia after midline
cesarean section is unknown. The aim of this study was to
analyze the incidence and risk factors for hernia after elective
lower midline caesarean section (CS). A prospective cohort
study of 284 women for incisional hernia development
after elective midline CS) was conducted at Prince Hashem
Ben Al-Hussein hospital from April 2006 to December
2008. All patients included had a history of at least two
previous CSs. Patients were divided in two groups: one
study group consisted of women who had an incisional
hernia and the control group consisted of women who had
not developed an incisional hernia within two years post
CS. Within the two groups, potential risk factors (age, body
mass index, parity, number of previous cesareans, type of
previous incision, chronic cough, diabetes mellitus, heart
disease, low albumin, anesthesia type, postoperative fever
and wound complications) were statistically analyzed
with the development of incisional hernia. The two year
Ibnosina Journal of Medicine and Biomedical Sciences (2011)
Hasan DS et al
206
ISSN: 1947-489X
207
Ibnosina J Med BS
Table 1. Demographic and Clinical data characteristics of the 284 women included in the study. Data are presented as meanstandard
deviation (range) or number (percentage):
Characteristics
Details
Age (years)
Parity
Smoking Status:
non smoker
196 (69%)
light smoker
53 (18.7%)
smoker
35 (12, 3%)
39 (13.7%)
Diabetes Mellitus:
19 (6.7%)
Gestational Diabetes:
36 (12.7%)
Heart Disease:
23(8.1%)
2.6 0.5
212 (74.6%)
Spinal anesthesia
72 (25.4%)
19 (6.7%)
Postoperative Fever
29 (10.2%)
Wound complications:
Superficial infection
14 (4.9%)
Hematoma
12 (4.2%)
Seroma
7 (2.5%)
Wound dehiscence
2 (0.7%)
Hasan DS et al
208
Results
Of the three hundred and nineteen patients, 13 (4%) were
excluded because of incomplete follow-up within two years
postoperatively, eight (2.5%) because of incomplete data,
and 14 (4.3%) because they became pregnant within two
Table 2. Comparison of demographic and clinical data characteristics of the women who developed incisional hernia versus
no hernia.
Data are presented as meanstandard deviation (range) or number (percentage).
Univariate
Multivariate
analyses
analyses
33.3 6.6
P value
0.43
P value
0.08
3.6 1.8
0.049
0.18
Incisional hernia
No incisional hernia
group(n=16)
group(n=268)
Age (years)
32 4.9
Parity:
Number of Previous Caesarean
4.6 1.4
Variables
29.6 2.7
26.2 3.2
<0.0001
<0.0001
4.2 1.3
3.1 1.2
0.006
<0.0001
4 (25%)
106 (39.7%)
0.24
0.31
Non smoker
10 (62.5%)
193 (72%)
0.65
0.49
Regular smoker
2 (12.5%)
32 (12%)
.07
Chronic cough
5 (31.3%)
34 (12.7%)
0.04
0.58
Diabetes Mellitus
5 (12.5%)
8 (3.2%)
0.048
0.82
Sections:
Type of Previous Scar:
Pfannenstiel
Midline
Smoking Habit:
Infrequent smoker
12 (75%)
4 (25%)
3 (18.8%)
2 (12.5%)
161 (60.3%)
0.24
43 (16%)
0.06
16 (6%)
0.13
21 (7.8%)
0.51
0.71
0.93
General
11 (68.7%)
201 (75%)
0.58
0.69
Operative Time
64.2 20.8
63.7 21.6
0.89
0.47
Level of albumin
2.5 0.36
2.6 0.46
0.12
0.35
Cellulitis
3 (18.8%)
11 (13.5%)
0.21
0.002
Seroma
3 (18.8%)
6 (8.5%)
<0.0001
Spinal
Blood Transfusion
Presence of fever
Wound Complications:
Hematoma
Wound dehiscence
www.ijmbs.org
5 (31.3%)
2 (12.5%)
3 (18.8%)
2 (12.5%)
67 (25%)
17 (6.3%)
0.39
26 (9.7%)
0.25
10 (11.3%)
0.89
2 (0.7%)
ISSN: 1947-489X
0.17
0.49
Ibnosina J Med BS
209
However, there were conflicting reports about the role of
wound infection as causative for IH, in particular long-term
hernia formation. While there are studies that confirm this
(18-20), others do not (21, 22). In this present study, we
found that increased BMI and wound complication were
independent risk factor for IH within the two-year cohort
study (Table 2). This may be the result of impaired collagen
synthesis at infected wound sites.
Previous studies recognized that the presence of diabetes
mellitus is a risk factor of incisional hernia occurrence (21).
Studies of this comorbidity flooded bias, lack of statistical
capacity, and reporting issues. The best current evidence,
however, does not suggest diabetes mellitus dramatically
affect incisional hernia rate 18. In our study, nearly half of
diabetic patients developed hernia later, which is significant
in comparison to non-diabetic patients.
Although this subgroup was too small to fully evaluate this
association. There is disagreement about whether smoking
influences the rate of incisional hernia. Some studies found
that smoking influence the rate of IH (23, 24), while other
researchers did not confirm this conclusion (18). Our study
could not confirm that smoking considerably alters the rate
of incisional hernia post-caesarean section.
Age, parity, previous incisional scar, gestational diabetes,
preoperative low albumin level, type of anesthesia, duration
of operation, perioperative blood transfusion, postoperative
fever and chronic cough were found to not be associated
with increase risk for hernia formation.
References
1. Oscar Agero. Eventraciones poscesrea. Rev
Obstet Ginecol Venez. Caracas sep 2005;65:11922.
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ISSN: 1947-489X