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.