174 Chapter 7 were represented by PS (209/411) and undescended testis (104/411). Wound infection occurred in 6% of the infants following main surgery. Out of all patients, 21% had received a stoma in their lifetime. The median total number of abdominal procedures the patients had undergone was one (range: 1-13). The median follow-up since the main surgery was 420 days (range 0-8006 days). Incisional hernia (IH) Details on the characteristics of IH cases are reported in Table 2. IH developed in 5.2% (107/2055) of the patients, which increased to 7.0% (76/1084) when only patients with a minimum follow-up of a year were included. The median time to IH development was 157 days (0 – 4933) with 68% (73/107) arising within a year following main surgery. The highest incidences of IH were reported in gastroschisis (19%, 10/53), omphalocele (17%, 7/42), NEC (12%, 22/188) and congenital umbilical hernia (11%, 6/54). PS showed an IH incidence of 4% (17/411) of which 53% (9/17) were early IHs. The incisional hernia was diagnosed by physical examination in 89% (95/107) and by ultrasound in 11% (12/107) infants. The presentation of the hernia was an asymptomatic swelling in 68% (73/107) of the infants, a swelling with pain and/or crying without signs of incarceration in 16% (17/107) and as an incarcerated hernia in 1% (1/107); in 15% (16/107) the way the IH presented was unknown. The IH developed at the site of a laparotomy (73%, 78/107), a trocar (15%, 16/107) or a closed stoma (8%, 9/107); in 3% (3/107) the site of occurrence was unknown. Out of the 16 trocar hernias, 50% (8/16) developed after using a 5 mm trocar and 19% (3/16) using a 3 mm trocar; in 31% (5/16) the trocar size was unknown. In all trocar hernias the fascia had been closed by suturing during the main operation. No information was reported on the length and width of the incisional hernias. The anatomical location of the IHs is provided in Appendix 2. Out of all IH, redo surgery was needed in 80% (86/107) of the patients. The redo was performed during primary admission in 21% (19/86) of which 75% (14/19) were early IHs. The redo was done by primary closure (98%, 84/86) or mesh (2%, 2/86). Following this redo surgery recurrence was seen in 5% (4/86), all of which were previously operated by primary closure. Primary closure was repeated without new recurrences. Out of the 21 patients who did not receive an operation to resolve the IH at our institute, follow up was available in 16 patients (15% of the total IHs). In all of these patients the IH resolved without surgery in a median day of 341 days (range: 7 – 1061 days). Risk factors for incisional hernia Multivariate logistic regression showed that congenital disease, age at operation, operative approach, urgent operation, ASA-score before the main operation, total number of operations and receiving total parenteral feeding during admission for the main operation were not significantly associated with IH development. Post-operative
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