Repair of midline incisional hernias using the Lazaro da Silva aponeuroplasty technique.

Study aim: The aim of this retrospective study was to assess Lazaro da Silv a's rectus sheath aponeuroplasty technique for repair of midline incisional hernias situated above the arcuate line. Patients and method: Twenty-six patients underwent surgical repair of a sup raumbilical (n = 19) or periumbilical (n = 7) incisional hernia. Six patien ts had had repeated laparotomies and two of them had recurrent incisional h ernia. There were II obese patients (42%). Muscle diastasis ranged from 4 t o 20 centimeters (mean: 9.7 cm). Three overlapping aponeurotic and peritone al layers were used. The peritoneal sac was partially or totally incorporat ed in the repair. Results: There was one postoperative death at day 5 from acute pancreatitis in a patient with associated cholecystectomy. Postoperative complications occurred in six patients. There were 3 abdominal wail infections. Obesity w as the main factor associated with operative complications (p = 0.03). Mean follow-up was 19.1 months. There were 2 recurrences, one of them related t o an abdominal wall infection. Conclusion: The Lazaro da Silva aponeuroplasty technique compares favourabl y with alternative techniques using mesh implants. It is indicated for inci sional hernias less than 20 centimeters wide, situated above the arcuate li ne. (C) 2000 Editions scientifiques et medicales Elsevier SAS.