SLIDING-DOOR TECHNIQUE FOR THE REPAIR OF MIDLINE INCISIONAL HERNIAS

We describe a technique that enables the autologous repair of large mi dline incisional hernias by restoring the functional musculoaponeuroti c support of the abdominal wall. Unlike other methods of hernia repair , the essential step of the sliding door technique is the complete rel ease of the rectus abdominis muscles from the anterior and posterior l ayers of their sheaths. The released muscles are thus overlapped and s utured together without tension. Another step of the technique is the release of both rectus sheaths by incising the aponeuroses of the exte rnal oblique muscles. We report on the use of this technique in 10 pat ients with midline incisional hernias (mean size of the abdominal musc ulofascial defect 14 x 11 cm). The patients were examined 14 months to 5.5 years after hernia repair. Two postoperative complications occurr ed: one marginal skill necrosis and one subcutaneous seroma. Recurrenc es were not observed. Ultrasound examination showed that the rectus mu scles maintained their overlapped position postoperatively, Clinical m uscle resting indicated tl-lat the strength of the released rectus mus cles provides functional support to the reconstructed anterior abdomin al wall.