Incisional Hernia Repair: A Retrospective Observational Study of Surgical Techniques, Patient Characteristics, and Postoperative Outcomes

Background: Incisional hernia is a common complication following abdominal surgery, often linked to patient- and technique-related factors. Despite surgical advancements, it remains a significant clinical challenge due to its high recurrence and complication rates. Objective: To evaluate the clinical characteristics, surgical techniques, and short-term postoperative outcomes in patients undergoing elective incisional hernia repair at a single center. Methods: A retrospective observational study was conducted at Safeer Al-Imam Al-Hussain Surgical Hospital in Karbalaa, Iraq, from May 2022 to February 2025. Forty adult patients who underwent elective mesh-based incisional hernia repair were included. Results: The mean age of patients was 44.5 ± 11.9 years, with 77.5% being female and a mean BMI of 35.5 ± 5.6 kg/m². Diabetes mellitus (17.5%) and hypertension (35%) were the most frequent comorbidities. CT imaging was used in 40% of cases to assess large defects or bowel involvement. The most common surgical technique was sublay + window (37.5%), followed by sublay + window + onlay (25%). Postoperative complications occurred in 22.5% of patients, with seroma (15%) and wound infection (7.5%) being the most common. Significant associations with complications were found for diabetes (p = 0.018), large hernia defect (p = 0.031), use of omentoplasty (p = 0.014), midline incision (p = 0.035), and concurrent abdominoplasty (p = 0.017). Conclusion: Incisional hernia repair remains complex, a tailored surgical approach and appropriate preoperative imaging are essential to optimize outcomes. Despite these challenges, the overall complication rate were minor and acceptable.