A SIMPLE STAPLING TECHNIQUE FOR PROSTHETIC REPAIR OF MASSIVE INCISIONAL HERNIAS

This article introduces a simpler, faster, and safer method of perform ing the Stoppa procedure with an articulating stapler. It also encoura ges use of preperitoneal repair instead of the often unsuccessful onla y mesh repair. The latter repair involves placing the mesh over the ab dominal aponeurotic layer and can result in a high incidence of infect ion, seroma accumulation, and chronic fibrous cyst formation. In the p reperitoneal repair technique, the same force that created the hernia- the intraabdominal hydrostatic pressure-keeps the mesh tightly in plac e and prevents recurrence of the hernia. The authors base their recomm endation of the stapling technique on the experience of 54 large incis ional hernias successfully repaired by preperitoneal insertion of a la rge sheet of Marlex mesh (Stoppa's procedure). In 29 of the 54 patient s, the mesh was fixed in place with hand suturing. In the other 25, ar ticulating staplers attached the mesh. The authors have found the stap ling technique to be both simpler to accomplish and safer for the pati ent.