Predisposing Factors and Occurrence Rate of Incisional Hernia after Open Abdomen Management

Main Article Content

Fahri yetişir, MD Kerim Güzel, MD


In recent years, since the number of surviving patients managed with open abdomen (OA) has been increasing very rapidly, management of some challenging sequel such as Incisional hernia (IH) come into consideration.

We would like to report our case series of IH developing after OA management and investigate the predisposing factors for hernia occurrence following OA management.

Data of OA patients managed between 2008 and 2014 were analyzed retrospectively. Only the fascial closure achieved OA patients were included in this study and examined in terms of IH.

Abdominal closure was achieved in 98(%90) of 108 OA patients. Complete closure (Fascial and skin) could be done in 63 OA patients and only skin closure was achieved in 35 OA patients. Complete closure achieved OA patients were included in this study. Mean follow up time was 20,8±13,6 months. 18.3% of them had hernias.  Mean Mannheim Peritonitis Index (MPI) score and Sequential Organ Failure Assessment (SOFA) score during OA management were significantly greater in hernia group than non-hernia group. The time interval between first laparotomy to first negative pressure therapy (NPT) application (time interval to first NPT) and the length of OA management were significantly longer in hernia group than non-hernia group. IH may be repaired approximately 144 days later from OA management.

Time interval to first NPT application and length of OA management were significantly longer in hernia group. If fascial closure could be achieved during OA management, reasonable ratios of IH with acceptable diameter might occur.

Keywords: Open abdomen, incisional hernia, negative pressure therapy, dynamic abdominal closure, delayed abdominal closure

Article Details

How to Cite
YETIŞIR, Fahri; GÜZEL, Kerim. Predisposing Factors and Occurrence Rate of Incisional Hernia after Open Abdomen Management. Medical Research Archives, [S.l.], v. 8, n. 4, apr. 2020. ISSN 2375-1924. Available at: <>. Date accessed: 14 june 2024. doi:
Research Articles


1. Kirkpatrick AW, Roberts DJ, De Waele J et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013);39(7):1190–1206.

2. Cheatham ML, Safcsak K Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med. 2010;38:402–7

3. Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy. Ann Surg.1983;197(5):532-5.

4.Yetişir F, Şarer AE, Acar HZ, Çiftciler E. The Reversal of Stoma Following Open Abdomen Management. Indian J Surg. 2016;78(3):182-6. doi: 10.1007/s12262-015-1336-2. Epub 2015 Sep 5.

5.Yetişir F, Şarer AE, Acar HZ, Aygar M. Delayed Closure of 61 Open Abdomen Patients Based on an Algorithm. Indian J Surg; 2017;79(1):38-44. doi: 10.1007/s12262-015-1422-5. Epub 2015 Dec 23.

6. Sarer AE, Yetisir F, Aygar M, Acar HZ, Polat Y, Osmanoglu G. Intra-abdominal Pressure Monitoring in Open Abdomen Management with Dynamic Abdominal Closure. Indian J Surg. 2017;79(5):384-389. doi: 10.1007/s12262-016-1491-0. Epub 2016 May 13.

7. Fernandez L G, Sibaja Alvarez P, Kaplan M J, et al. Application of NegativePressure Wound Therapy with Instillation and Dwell Time of the Open Abdomen: Initial Experience. Cureu. 2019; 11(9): e5667. DOI 10.7759/cureus.5667

8. Tian W, Huang Q, Yao Z et al. A preliminary prospective study of patients who underwent vacuum-assisted and mesh-mediated fascial traction techniques for open abdomen management with negative fluid therapy: An observational study. Medicine (Baltimore). 2019;98(35):e16617.

9. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional abdominal wall hernias. Hernia.2009;13:407–14.

10. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg.2004;240:578–83

11. Boele van HP, Wind J, Dijkgraaf MG, Busch OR, Goslings JC. Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J. Surg.2009;33(2):199–207.

12. Petro CC1, Como JJ, Yee S et al. Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen. J Trauma Acute Care Surg.2015;78(2):422-

13. Salman A.E, Yetişir F, Aksoy M, Tokaç M, Yıldırım M.B, Kılıç M. Use Of Dynamic Wound Closure System In Conjunction With Vacuum Assisted Closure Therapy In Delayed Closure Of Open Abdomen. Hernia.2014;18:99-104

14. Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg.2004;240(2):205–13.

15. Lambertz A, MihatschCh, Röth Aetal. Fascial closure after open abdomen: initial indication and early revisions are decisive factors-a retrospective cohort study. Int J Surg.2015;13:12-6.

16. Scott BG, Feanny MA, Hirshberg A. Early definitive closure of the open abdomen: a quiet revolution, Scand. J. Surg.2005;94: 9–14,

17. Scott BG, Welsh FJ, Pham HQ et al. Early aggressive closure of the open abdomen, J Trauma.2006 ;60:17-22.

18. Koss W, Ho HC, Yu M et al. Preventing loss of domain: a management strategy for closure of the “open abdomen” during the initial hospitalization. J Surg Educ.2009;66(2):89-95

19. Bjarnason T, Montgomery A, Ekberg Oetal. One-year follow-up after open abdomen therapy with vacuum-assisted wound closure and mesh-mediated fascial traction. World J Surg.2013;37:2031-8.

20. Cothren CC, Moore EE, Johnson JL et al. One hundred percent fascial approximation with sequential abdominal closure of the open abdomen. Am J Surg.2006;192:238–42

21. Petersson U, Acosta S, Bjorck M. Vacuum-assisted wound closure and mesh-mediated fascial traction: a novel technique for late closure of the open abdomen. World J Surg.2007;31:2133–2137.

22.Yetisir F, Salman AE, Ozdemir F, Durak D, Ozlu O, Kilic M (2013) Modified application of dynamic wound closure system in the management of septic open abdomen. World Journal of Trauma and Critical Care Medicine.2013; 1:1-8.

23. Bosanquet DC, Ansell J, Abdelrahman T et al. Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14,618 Patients. PLoS One.2015:21;10(9):e0138745. doi: 10.1371/journal.pone.0138745

24. Slater NJ, van der Kolk M, Hendriks T, van Goor H, Bleichrodt RP. Biologic grafts for ventral hernia repair: a systematic review. Am J Surg. 2013;205(2):220–30

25. Deeken CR. Biologic Mesh: Classification and evidence-based critical appraisal. Hernia Surgery. 2016;61(69)

26. Popescu GA, Bara T, Rad P. Abdominal Compartment Syndrome as a Multidisciplinary Challenge. A Literature Review. J Crit Care Med (Targu Mures). 2018 Oct 1;4(4):114-119. doi: 10.2478/jccm-2018-0024. eCollection 2018 Oct.

27. Yetişir F, Sarer AE. Operative Management of Enteroatmospheric Fistula in Björck 4 Open Abdomen Patients by the Help of Laparoscopic Lateral Approach. Indian J Surg. 2017;79(2):173-176. doi: 10.1007/s12262-017-1595-1. Epub 2017 Jan 20. PMID: 28442849