INCISIONAL HERNIA REPAIR WITH AN UNDERLAY POLYPROPYLENE MESH PLASTY -AN EXCELLENT TECHNIQUE FROM FRENCH HERNIA SURGEONS

Incisional hernia repair with conventional techniques (simple closure, Mayo-technique) is associated with unacceptable recurrence rates of 3 0-50%. Therefore, surgical repair using different prosthetic biomateri als is becoming increasingly popular. Further to favourable results by French hernia surgeons, we studied the results of underlay prosthetic mesh repair using polypropylene mesh in complicated and recurrent inc isional hernias. Method: After preparation and excision of the entire hernia sac, the posterior rectus sheath is freed from the muscle belli es on both sides. The peritoneum and posterior rectus sheaths are clos ed with a continuous looped polyglyconate suture. The prosthesis used for midline hernias is positioned on the posterior rectus sheath and e xtends far beyond the borders of the myoaponeurotic defect. The anteri or rectus sheath is closed with a continuous suture. The prosthesis fo r lumbar and subcostal hernias is placed in a prepared space between t he transverse and oblique muscles. Intraperitoneal placement of the me sh must be avoided. Results: Between January 1996 and August 1997 we p erformed a total of 33 incisional hernia repairs (14 primary hernias, 19 recurrent hernias) using this technique (16 women, 17 men, mean age 56.19 +/- 12.92 years). Local complications occurred in four patients (12%): superficial wound infection (n = 2), postoperative bleeding, r equiring reoperation (n = 1), minor hemato-seroma (n = 1). One patient suddenly died on the 3rd post-operative day from severe pulmonary emb olism (mortality 3%). Twenty-two patients with a minimum follow up to 6 months were re-examined clinically. The average follow-up time for t his group was 9 months (range 6-17 months). To date no recurrent herni as have been observed. There were only minor complaints like ''a feeli ng of tension'' in the abdominal wall (n = 3) and slight pain under ph ysical stress (n = 6). Conclusions: The use of prosthetic mesh should be considered for repair of large or recurrent incisional hernias, esp ecially in high-risk patients (obesity, obstructive lung disease) and complicated hernias. The aforementioned technique of underlay prosthet ic repair using polypropylene mesh fixed onto the posterior rectus she ath allows for anatomical and consolidated reconstruction of the damag ed abdominal wall with excellent results and low complication rates.