Subxiphoid incisional hernias post median sternotomy: A Literature review

Jeremy Chan¹, James O’Hanlon², Joshua McKenna³, Shwe Oo⁴

1: MB BCh BAO, PgDip (ClinEd), Bristol Medical School, University of Bristol, Bristol, United Kingdom

2: MSci, Swansea University Medical School, Swansea University, Swansea, United Kingdom

3. BSc (Hons), Swansea University Medical School, Swansea University, Swansea, United Kingdom

4. MRCS, PgCert (ClinEd), Department of Cardiothoracic Surgery, Bristol Royal Infirmary, Bristol, United Kingdom

Corresponding author

Dr Jeremy Chan MB BCh BAO, PgDip (ClinEd) Bristol Medical School University of Bristol, Bristol, United Kingdom Email:jeremychan@doctors.org.uk

Keywords: Subxiphoid hernia, Incisional Hernia, Literature review

Word Count: 1821

Funding: (None)

Disclosure: Nil

Acknowledgement: Nil

Presentation: Nil

Abstract

Background: Subxiphoid incisional hernias are one of the complications following a median sternotomy, a surgical procedure to provide access to the mediastinum. Incidence has been reported between 1-4%, although the true incidence is not well known due to its asymptomatic nature.

Method: A comprehensive search was performed on multiple sites. Keywords included “incisional hernia OR Subxiphoid hernia” AND “Median sternotomy OR Cardiac Surgery OR Coronary artery bypass graft OR Transplant OR Valve replacement”. Articles up to 1^stof August 2020 were included in this study.

Results: 8 articles were included in the study, with a total number of 132 patient identified. The incidence 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%.

Conclusion: Subxiphoid incisional hernias remain\souts challenging to manage. We have discussed the incidence, risk factors, preventions, and management of subxiphoid incisional hernias including both the open and laparoscopic technique.