Laurens Schattenkerk

137 Incisional hernia after surgical correction of abdominal congenital anomalies in infants Chapter 5 Also, an increased risk of IH was present when SILO closure was performed compared to primary closure (Figure 4) with an odds ratio of 3.09 (95% CI: 1.63-5.87; p ≤ 0.01; I2 = 27%). Figure 4 - Forest plot SILO vs primary closure Discussion This systematic review pooled the reported proportions on incisional hernia following abdominal surgery for congenital anomalies in infants. These proportions approximate the incidences of these complications. Therefore, our reported approximation of the incidence of IH was 3%. Within the different congenital anomalies gastroschisis patients are most at risk with an approximated incidence of 10%. In subgroup analysis complex gastroschisis (patients with GS and additional anomalies) and SILO closure were identified as risk factors for IH. Studies reporting on laparoscopy and laparotomy seem to have similar incidences of IH although, due to the design of included studies, we were not able to compare studies. Still, this seems to be in line with previous cohort studies that focused on incisional hernia specifically in pediatric patients. These studies opted that the occurrence of IH seems to be more related to specific diagnosis instead of mode of surgery [15, 354]. Within the included studies type of incision was only scarcely reported. Out of those that did, none reported the use of a midline incision. Transverse incision was the most reported type of incision. The use of this incision in infants provides a surgeon the best exposure to the abdominal cavity in neonates. The abdominal cavity of infants resembles a horizontal ellipsoid. With age and growth this ellipsoid changes into vertical position [355]. Thus, the younger the child the better visualization is obtained by using a transverse incision. Transverse incisions have been shown to have a lower incidence of IH compared to midline incision in adults [356, 357]. Previous studies suggested that the acquired newborn abdominal diseases necrotizing enterocolitis and pyloromyotomy are at higher risk for the development of IH [354, 358]. Our review shows that the congenital abdominal wall defects gastroschisis and omphalocele should be added to this list.

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