The Impact of a Specialized Team in the Management of Patients With Incisional Hernias: Experience From a Secondary Public Hospital.

Abstract

<h4>Introduction</h4>Large incisional hernia is a complex pathology, and its treatment yields better outcomes when performed by a surgical team specialized in abdominal wall management. Waiting lists are long, and many patients fail to meet the minimum criteria for surgery due to morbid obesity, poor control of comorbidities, or ongoing smoking. While waiting, patients often experience pain crises, increased hernia volume, loss of function, financial deterioration, and emergency procedures. In such contexts, surgery has high rates of mortality, infection, and hernia recurrence. Expanding the number of hospitals and trained teams able to perform high-quality, large incisional hernia repairs is a promising strategy to reduce wait times and improve outcomes.<h4>Methods</h4>We conducted a retrospective observational study including 87 patients who underwent incisional hernioplasty between August 2019 and December 2023 at a medium-complexity public hospital. Patients with hernia defects larger than 6 cm were included. Data were collected from medical and surgical records. Patients with primary, parastomal, or inguinal hernias were excluded. Statistical analysis was performed using Stata Statistical Software: Release 12.0 (StataCorp LLC, College Station, Texas, United States), with logistic regression applied to identify predictors of surgical site infection, hernia recurrence, and reintervention. A p-value ≤ 0.05 was considered statistically significant Results: Among the 87 patients included, surgical site infection occurred in 22 (25.3%). In multivariate analysis, surgical site infection was independently associated with seroma (OR 3.77; 95%CI 1.37-10.34; p = 0.01) and wound dehiscence (OR 5.73; 95%CI 1.80-18.23; p = 0.003). Hernia recurrence was significantly associated with diabetes (OR 2.23; 95%CI 1.22-25.95; p = 0.026), hypothyroidism (OR 2.04; 95%CI 1.06-26.56; p = 0.041), dehiscence (OR 2.22; 95%CI 1.22-25.42; p = 0.026), and surgical site infection (OR 2.86; 95%CI 2.17-64.13; p = 0.004).<h4>Conclusion</h4>This study adds evidence supporting the establishment of specialized teams and targeted care for patients with incisional hernias within the Brazilian Unified Health System (SUS).