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Abstract

Objective: To compare the outcome of early versus late repair of incisional hernia that developed following laparostomy for enterocutaneous fistula.
Material and methods: This Randomized controlled trial study was conducted at Surgical C unit, Lady Reading Hospital, Peshawar from 22nd May, 2014 till 21st May, 2017. Following ethical approval, 69 patients were enrolled in the study, amongst which three were lost to follow-up. So, 33 patients in both groups were later on included. In group A, patients were asked to present at an early 3-month delay following confirmation of successful enterocutaneous fistula management after discharge, and Group B patients were asked to come one year later. Both groups were subjected to the same procedure of component separation technique with reinforcement with polypropylene mesh. Data was recorded on a Proforma and post-operative complications were mentioned for a period of 12 months that included seroma/hematoma formation, superficial wound infection, mesh infection, enterocutaneous fistulas, recurrence and mortality.
Results: Following allocation to two groups, the group planned for surgery by the component separation technique (CST) in the early group had a slightly smaller hernia (21.3cm) but this was not significant a difference in comparison (p=0.68). The study was focused at a follow-up for duration for one year during which 19 patients (28.7%) in total had clinical or radiological evidence of recurrence of the incisional Hernia out of which ten patients(30.3%) were from group A. Recurrence in group B occurred in 9 patients(27.2%) (p=0.88) This included three patients (4.5%) from both groups with infected meshes that needed removal.
Conclusion: Component Separation technique is a feasible staged approach to management of a ventral wall defect (incisional hernia) with reinforcement of the wall with polypropylene mesh in early phase of recovery after enterocutaneous fi stulas.