Introduction
Subxiphoid incisional hernias
(SIH) are a recognised complication following a median sternotomy. SIH
is known to be difficult to repair and therefore associated with a high
rate of recurrence. (1-3) SIH occurs due to a defect created during
median sternotomy. The defect mainly occurs in the caudal part of the
sternotomy that allows protrusion of tissue such as fat or bowel. While
the reported incidence of SIH is relatively low, at 1-4.2%,(4) the true
incidence is not fully understood due to their asymptomatic nature, and
the tendency to recur post repair. (5) Several articles have been
reported their experiences of minimising the risk of developing SIH as
well as open and laparoscopic repair of SIH. We, therefore, aim to
perform a literature review to summarise the existing shreds of evidence
available in the research
field.
Method
A comprehensive search was performed on PubMed, Ovid, SCOPUS, EMBASE,
Cochrane library and Google Scholar. The search terms included
“incisional hernia OR Subxiphoid hernia” AND “Median sternotomy OR
Cardiac Surgery OR Coronary artery bypass graft”. Articles published
prior 1st of August 2020 were included in this study.
All types of publication were included for review. The references of the
identified articles were then searched for any potential articles that
can be included. A literature search was performed by two reviewers (JM
and JOH) independently. A further review was performed by the third
reviewer (JC). Articles that discussed the incidence and the management
of SIH were included. Case reports, expert opinion, editorials,
duplicates studies, and conference abstracts were excluded.
Results
8 articles were included in the study. The incidence of SIH, number of
patients included, repair method, recurrence rate and follow up data
were summarised in table 1. All studies were performed retrospectively,
with a total number of 132 patients included. (ranged 4-45) All 132
patients underwent median sternotomy for coronary artery bypass
grafting, valve replacement or cardiac transplant. The incidence
reported in 3 out of 8 articles, ranged from 0.81% to 3.44%. There was
a mixture of repair method and follow up period reported. Recurrence
post-repair ranged from 10% to 43%, this is likely due to small sample
size included in the study.