Ventral Rectus Fascia Closure on Top of Mesh Hernia Repair in the Sublay Technique

Abstract

Sublay prosthetic herniorrhaphy has become a widely accepted procedure for incisional hernias. To evaluate the effect of fascia closure on top of mesh repair on infection, and the recurrence rate, the authors reviewed their data regarding herniorrhaphy in the sublay technique. This study was a retrospective analysis of 175 consecutive patients who underwent hernia repair by implantation of prostheses by means of the Stoppa-Rives technique from December of 1994 to December of 2001. All 175 patients had the mesh implanted in the subfascial plane, 130 received a light-weight or heavy-weight polypropylene mesh (Vypro or Prolene) (74 percent), eight had a polyester mesh (Mersilene) (5 percent), and 37 had an expanded polytetrafluoroethylene patch (Gore-Tex) (21 percent). After sublay mesh positioning, the mesh could not be covered by the fascia in 50 cases; in 31 of these cases, a second mesh was placed into the fascial defect. To evaluate the influence of the fascia closing procedure on top of the sublay mesh, three groups were differentiated: initial fascia closure (n = 125), no fascia closure and concomitant mesh interposition (n = 31), and no fascia closure without mesh interposition (n = 19). After a mean follow-up of 20 months, 11 deep prosthetic infections (8 percent) and 15 hernia recurrences (9 percent) were observed. There was an increased risk of mesh infection when the fascia could not be closed, but there was no influence of fascia closure on hernia recurrence. When the fascia was left open, the placement of a second mesh inlay technique reduced mesh infection. The authors' data give evidence that closing the ventral fascia after mesh repair in the sublay position is beneficial. When the edges of the hernia defect could not be approximated, the suturing of a second mesh into the fascia defect was a useful tool for reducing the prosthetic infection rate; however, no significant influence on hernia recurrence was observed.

A new technique for tension-free reconstruction in large incisional hernia

“…This option has the advantage of avoiding placement of the mesh subcutaneously without any fascial covering, leading to high risk of infection. Petersen et al [ 22 ] demonstrated the importance of closure of the rectus sheath ventral to the prosthesis during the retromuscular repair of incisional hernias. He found that the risk of deep prosthetic infection in patients in which it was not possible to close the rectus sheath above was 13 times higher than patients who received closure over the mesh.…”

A New Alternative Technique for Preperitoneal Inguinal Hernia Repair: Using Groin Innominate Fascial Island Flap

“…Excellent results have been achieved and reported recurrence rates have been less than 1 percent [4]. On the other hand these synthetic materials are physically and chemically inert, induce minimal inflammatory or foreign body reaction, resist mechanical strains, and cause seroma, testicular atrophy, chronic pain, and infection [2,3,6,7]. Avoiding for these complications, biomaterials which includes bioabsorbable polyglycolic acid and self reinforced polyglycolic acid have been developed and used in the experimental and clinical studies [5,7].…”

“…Various Copyright © 2012 SciRes. SS F. KURT, M. ABEŞ 364 types of prosthetic materials which include polyester, mersilene, prolene, polypropylene, and expanded polytetrafluoroethylene meshes have been developed and commonly used for the reinforcement of the weakened abdominal wall [2,3,5]. Prosthetic materials allow the hernia to be repaired without tension being placed on the surrounding tissue.…”

“…Despite reported low recurrence rates and improvement results, the optimal surgical technique has not been found and recurrence was not eliminated [1,2]. Several prosthetic materials, fascial flaps and aponeurotic flaps have been used for reinforcement of weak inguinal tissues and eliminating recurrence [1][2][3][4][5][6][7][8][9][10][11]. We used an open anterior procedure which combined with groin innominate fascial island flap to reinforce the weak inguinal tissue for the repair.…”

Concomitant sublay mesh repair of umbilical hernia and abdominoplasty

“…From a mechanical standpoint, mesh positioned posterior to the fascial defect takes advantage of Pascal's principle of hydrostatics by distributing the intra-abdominal forces over the surface area of the mesh. The retrorectus space or preperitoneal space is a well-vascularized domain where mesh can incorporate with reduced risk of infection (14). Avoidance of mesh placement in the intraperitoneal cavity is attractive to avoid the adhesive potential and possibility of future mesh-related complications (15).…”