Behind the scar: a narrative review of risk factors for incisional hernia following open abdominal aortic aneurysm repair
DOI:
https://doi.org/10.48750/acv.679Keywords:
abdominal aortic aneurysm, open repair, incisional hernia, risk factorsAbstract
OBJECTIVE: Incisional hernia (IH) is a well- documented complication after open abdominal aortic aneurysm (AAA) repair, with incidence rates that may be higher than historically reported. Understanding risk factors for IH development is important for optimizing perioperative strategies and long- term patient outcomes. This narrative review summarizes and discusses the main risk factors associated with IH after open AAA repair.
METHODS: A comprehensive narrative review was conducted using PubMed. Keywords included "incisional hernia", "abdominal aortic aneurysm", "open repair", and "risk factors". Original articles, cohort studies, and reviews were selected to provide an objective analysis of current knowledge on this topic.
RESULTS: This review included 10 studies comprising 10438 patients, including observational studies, randomized controlled trials, and systematic reviews. The reported incidence of IH ranged from 5.2%5.2% to 46.5%46.5% . Patient- related risk factors included obesity, smoking, chronic obstructive pulmonary disease, diabetes mellitus, and chronic kidney disease. Surgical risk factors, such as midline incisions, surgical site infection, and inadequate closure techniques, were also associated with increased IH risk. Prophylactic mesh at abdominal closure reduced hernia incidence in high- risk individuals.
CONCLUSION: Understanding the multifactorial etiology and potential specific risk factors for IH after open AAA repair is essential for guiding preventive strategies. We found that obesity, smoking, chronic obstructive pulmonary disease, diabetes mellitus, chronic kidney disease, and surgical factors such as midline incisions or inadequate closure techniques could negatively affect IH development after open AAA repair. Considering prophylactic mesh reinforcement in selected cases may help reduce this complication.
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