Incisional hernias develop in up to 11% of surgical abdominal wounds with a
possible recurrence following repair of 44%, We describe our experience wi
th a combined fascial and prosthetic mesh repair. Thirty-five patients (16M
:19F) have been treated. The original operation was bowel related in 19 cas
es, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic ane
urysm repair in 2 and involved a thoraco-laparotomy in 3, The incisions wer
e midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one
patient. The hernias were considered subjectively to be large in 15, medium
in 14 and small in 6 of the patients. A proforma was completed for each pa
tient noting intra-operative and post-operative complications, post-operati
ve hospital stay and analgesic requirements. Post-operative complications i
ncluded seroma formation in 6 patients, deep vein thrombosis in one and a n
on-fatal pulmonary embolism in another. One patient developed a wound haema
toma and one had a superficial wound infection. Post-operative in-hospital
stay ranged from 1 to 27 days with a mean of 6.2 days, Of the 35 patients 3
3 were available for follow-up. Follow-up was for a median of 20.3 months (
range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent
lump and one (3%) reported persistent pain but none of the remaining 33 wa
s found to have a recurrence. We advocate this technique because it is appl
icable to all hernias, most of the mesh is behind the rectus sheath and has
2 points of fixation, it is relatively pain-free allowing early mobilisati
on, has a modest complication rate and a low recurrence rate.