Objective To investigate the clinical efficacy of open anterior myofascial repair surgery on abdominal wall incision hernia.

Methods The retrospective cohort study was conducted. The clinical data of 188 patients who underwent open anterior myofascial repair surgery on abdo-minal wall incision hernia at three medical centers, including Xiangya Hospital of Central South University et al, from December 2016 to December 2024 were collected. There were 85 males and 103 females, aged (62±12)years. Of the 188 patients, 55 cases had large incisional hernia and 133 cases had non‑large incisional hernia. Observation indicators: (1) intraoperative conditions; (2) postopera-tive conditions; (3) follow‑up. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann‑Whitney U test. Comparison of count data between groups was conducted using the chi‑square test or Fisher exact test. Comparison of ordinal data between groups was conducted using the nonparametic test.

Results (1) Intra-operative conditions. The operation time of the 55 patients with large incisional hernia was (145±40)minutes, and the volume of intraoperative blood loss was 40.0(22.5,55.0)mL, cases with fascial defect located in the central anterior abdominal wall, the superolateral quadrant, the inferolateral quadrant were 26, 7, 22, the fascial defect area was 140(99,169)cm², cases used with self‑fixating mesh and flat mesh were 29, 26. The above indicators of the 133 patients with non‑large incisional hernia were (124±34)minutes, 35.0(30.0,45.0)mL, 47, 26, 60, 25(12,40)cm², 67, 66, respectively. There were significant differences in operation time and fascial defect area between patients with large incisional hernia and non‑large incisional hernia (t=-3.651, Z=-10.339, P<0.05), and there was no significant difference in the volume of intraoperative blood loss, defect quadrant distribution, and mesh type (Z=-0.501, χ²=2.692, 0.086, P>0.05). (2) Postoperative conditions. Of the 55 patients with large incisional hernia, 7 cases developed postoperative seroma, including 5 cases combined with concomitant surgical‑site infection, and 4 additional cases developed with surgical‑site infection. Of the 133 patients with non‑large incisional hernia, 15 cases developed postoperative seroma, including 3 cases combined with concomitant surgical‑site infection. There was a significant difference in surgical‑site infection between patients with large incisional hernia and non‑large incisional hernia (χ²=10.707, P<0.05), and there was no significant difference in postoperative seroma (χ²=0.079, P>0.05). The duration of postoperative hospital stay was 7(6, 9)days for the 55 patients with large incisional hernia and 5(4, 6)days for the 133 patients with non‑large incisional hernia, showing a significant difference between them (Z=-6.292, P<0.05). (3) Follow‑up. All 188 patients were followed up for 43(range, 29-67)months. During the follow‑up, 9 patients experienced hernia recurrence, including 7 patients with large incisional hernia and 2 patients with non‑large incisional hernia. For the 7 patients of large incisional hernia with hernia recurrence, 4 cases underwent reoperation and 3 cases received conservative treatment. All 2 patients of non‑large incisional hernia with hernia recurrence received conservative treatment. There was no significant difference in hernia recurrence between patients with large incisional hernia and non‑large incisional hernia (χ²=8.432, P<0.05). Results of chronic pain score at postoperative 3 month showed that among 55 patients with large incisional hernia, 40 cases had mild pain, 7 cases had moderate pain, and 8 cases had severe pain. Among 133 patients with non‑large incisional hernia, the above indicators were 102, 28, and 3, respectively. There was no significant difference in chronic pain score at postoperative 3 month between patients with large incisional hernia and non‑large incisional hernia (Z=-0.968, P>0.05).

Conclusions Open anterior myofascial repair surgery can be used for the treatment of abdominal wall incision hernia. Compared with non-large incisional hernia, patients with large incisional hernia have longer operation time, are more prone to surgical-site infection, have longer postoperative hospital stay, and are more likely to experience hernia recurrence.