Summary
Incisional hernias occur in 5–10% of patients who have undergone laparotomy and are
associated with a high morbidity and significant socioeconomic costs. Better understanding
of the anatomy and improved methods for reinforcement of the abdominal wall with alloplastic
meshes have reduced the recurrence rate to 1–10% depending on the type of hernia and
the technique employed. A number of surgical repair techniques and mesh types are
available. However, precise criteria for incorporating patient body type, risk factors
for recurrence, hernia morphology, and the available biomaterials into planning of
the surgical approach (open versus laparoscopic) have yet to be established. The elaboration
of such criteria would require comparative evaluation of long-term results in a sufficiently
large number of patients, e.g. in multicentre trials or meta-analyses of standardised
data from different centres. Current classifications have the drawback that they fail
to take account of prognostically relevant risk factors for recurrence and are not
self-explanatory. The authors present a classification of incisional hernias that
is self-explanatory and practicable in routine clinical practice. Based on the cornerstones
of morphology (M), hernia size in cm (S), and risk factors for recurrence (RF), the
scheme enables easy description and documentation of the hernia, and provides evidence
for the indications and limitations of the main surgical repair techniques. Since
randomised studies can scarcely be conducted on incisional hernias due to the numerous
morphological variables, the classification presented here may offer an alternative
means for comparative data analysis.
Keywords
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Article info
Publication history
Published online: January 22, 2007
Accepted:
October 27,
2006
Received:
March 14,
2006
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
