Abstract
Background
Mesh techniques are the methods of choice for the repair of incisional hernias since these are due to the formation of unstable scar tissue.
Methods
We review the materials and techniques used in the repair of incisional hernias. We describe in detail the operative technique performed in our clinic, the pitfalls of the repair, and the overlap behind the xiphoid and the pubic bone.
Results
Polypropylene is the material widely used for open mesh repair. New developments have led to low-weight, large-pore polypropylene prostheses, which are adjusted to the physiological requirements of the abdominal wall and permit a proper tissue integration. These meshes provide the possibility of forming a scar net instead of a stiff scar plate and therefore help to avoid former known mesh complications.
Conclusions
The ideal position for the mesh is the retromuscular sublay position where the force of the abdominal pressure holds the prosthesis against the deep surface of the muscles. The lowest incidence rates of recurrence have been reported for the retromuscular sublay repair; even after long-term follow-up recurrence rates of 10% are possible. Attaining such good results requires an adequate size of the mesh with sufficient overlap of at least 5–6 cm in all directions. Open mesh repair using modern low-weight polypropylene meshes in the retromuscular sublay technique offers excellent results for the treatment of incisional hernias.
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References
Chevrel J, Rath A (1999) Polyester mesh for incision hernia repair. In: Schumpelick V, Kingsnorth A (eds) Incision hernia. Springer, Berlin Heidelberg New York, pp 327–333
Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj R, Klosterhalfen B (2001) Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg 14:47–54
Klinge U, Klosterhalfen B, Birkenauer V, Junge K, Conze J, Schumpelick V (2002) Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res 103:208–214
Klinge U, Junge K, Stumpf M, Oettinger AP, Klosterhalfen B (2002) Functional and morphologic evaluation of a low-weight, monofilament polypropylene mesh for hernia repair. J Biomed Mater Res 63:129–136
Klosterhalfen B, Klinge U, Schumpelick V (1998) Functional and morphologic evaluation of different polypropylene mesh modifications for abdominal wall repair. Biomaterials 19:2235–2246
Ladurner R, Trupka A, Schmidbauer S, Hallfeldt K (2001) The use of a underlay polypropylene mesh in complicated incisional hernias: successful French surgical technique. Minerva Chir 56:111–117
Langer I, Herzog U, Schuppisser JP, Ackermann C, Tondelli P (1996) Preperitoneal prosthesis implantation in surgical management of recurrent inguinal hernia. Retrospective evaluation of our results 1989–1994. Chirurg 67:394–402
Liakakos T, Karanikas I, Panagiotidis H, Dendrinos S (1994) Use of Marlex mesh in the repair of recurrent incision hernia. Br J Surg 81:248–249
Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, Ijzermans JN, et al (2000) A comparison of suture repair with mesh repair for incision hernia. N Engl J Med 343:392–398
Martin-Duce A, Noguerales F, Villeta R, Hernandez P, Lozano O, Keller J, et al (2001) Modifications to Rives technique for midline incision hernia repair. Hernia 5:70–72
McLanahan D, King LT, Weems C, Novotney M, Gibson K (1997) Retrorectus prosthetic mesh repair of midline abdominal hernia. Am J Surg 173:445–449
Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124:816–821
Schumpelick V, Conze J, Klinge U (1996) Preperitoneal mesh-plasty in incisional hernia repair. A comparative retrospective study of 272 operated incision hernias. Chirurg 67:1028–1035
Schumpelick V, Klosterhalfen B, Müller M, Klinge U (1999) Minimized polypropylene mesh for preperitoneal net plasty of incisional hernia. Chirurg 70:422–430
Si Z, Bhardwaj R, Rosch R, Klosterhalfen B, Klinge U, Rhanjit B, Mertens PR (2002) Impaired balance of type I and type III procollagen mRNA in cultured fibroblasts of patients with incision hernia. Surgery 131:324–331
Sugerman HJ, Kellum JM, Reines HD, DeMaria EJ, Newsome HH, Lowry JW (1996) Greater risk of incision hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171:80–84
Temudom T, Siadati M, Sarr MG (1996) Repair of complex giant or recurrent ventral hernias by using tension-free intraparietal prostetic mesh. Lessons learned from our initial experience. Surgery 120:738–743
Toniato A, Pagetta C, Bernante P, Piotto A, Pelizzo MR (2002) Incisional hernia treatment with progressive pneumoperitoneum and retromuscular prosthetic hernioplasty. Langenbecks Arch Surg 387:246–148
Usher F (1962) Hernia repair with Marlex mesh. Arch Surg 84:73–76
Welty G, Klinge U, Klosterhalfen B, Kasperk R, Schumpelick V (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5:142–147
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Schumpelick, V., Klinge, U., Junge, K. et al. Incisional abdominal hernia: the open mesh repair. Langenbecks Arch Surg 389, 1–5 (2004). https://doi.org/10.1007/s00423-003-0352-z
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DOI: https://doi.org/10.1007/s00423-003-0352-z