dramatically reduced by modern TFRs.

COMPLICATIONS

Table 72-16 Complications of Herniorrhaphy

Surgical Site Occurrences. Surgical site occurrences include superficial, deep, and organ space surgical

site infections (SSIs) and wound dehiscence. The incidence of surgical site infection for incisional hernia

is in the range of 10% to 15%, and is probably related to wound ischemia due to the required flap

dissection. Other factors leading to infection are pre-existing infection or ulceration of the skin over the

hernia, obesity, incarcerated or obstructed bowel within the hernia, and perforation of the bowel at the

time of hernia repair. Risk models developed for predicting SSI risk include the Ventral Hernia Risk

Score (VHRS) and the Hernia Wound Risk Assessment Tool (HW-RAT) using preoperative patient

characteristics, operative factors, and wound characteristics which identify patients at increased risk for

surgical site occurrences and can be used to guide clinical decisions and patient counseling (Table 72-17;

Fig. 72-47).161,162

Seromas. Seromas are common with extensive flap dissection in large ventral hernias and with the use

of synthetic mesh in laparoscopic hernia repairs and are possibly related to the size of the mesh used.

The fluid eventually resorbs spontaneously. Aspiration is performed for symptomatic relief only.

Bleeding. Bleeding and postoperative hematomas are common complications of hernia repair. Adequate

hemostasis should be ensured especially if large flaps are raised to prevent this complication.

Hematomas, like seromas, tend to get infected and should be monitored closely.

Prosthetic Complications. Shrinkage of polypropylene and other meshes should be considered by

surgeons when performing prosthetic repairs. Sufficient overlap anticipating a 20% contracture is

accepted by most. The decrease in size is felt to be due to scarification of the recipient’s tissue.

Intestinal obstruction or fistulization is possible by erosion, especially if there is physical contact

between intestine and the prosthesis. Intra-abdominal placement of a mesh prosthesis should be avoided

in favor of ePTFE or perhaps a biologic prosthesis whenever possible. Rejection because of an allergic

response is possible but extremely rare.

Complications Related to Laparoscopy

1973

These complications have been described above and include gas embolism, visceral injury, bladder

injury, bowel obstruction, diaphragmatic dysfunction, and hypercapnia.

Table 72-17 HW RAT Breakdown of Risk Factors for Wound Complications

Figure 72-47. A,B: Ventral Hernia Risk Score (VHRS) for surgical site occurrence and surgical site infection.

1974

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