World Journal of Surgery

, Volume 37, Issue 3, pp 538–544 | Cite as

Lateral Incisional Hernia Repair by the Retromuscular Approach with Polyester Standard Mesh: Topographic Considerations and Long-term Follow-up of 61 Consecutive Patients

  • Nicolas Veyrie
  • Tigran Poghosyan
  • Nicola Corigliano
  • Guillaume Canard
  • Stephane Servajean
  • Jean-Luc Bouillot



Because of the lack of published data and the relative rarity of lateral incisional hernia (LIH), their repair remains a major challenge for surgeons. The aim of the present study was to evaluate the outcome of LIH treated by the retromuscular approach (RMA) with a polyester standard mesh.


Sixty-one patients were treated between June 2000 and November 2007 in an academic tertiary referral center using one standardized surgical technique and one type of mesh. Lumbar incisional hernia was excluded. All data were prospectively culled. The early complications and recurrence rates were evaluated.


There were 14 (23 %) subcostal, 12 (19.6 %) flank, and 35 (57.4 %) iliac fossa LIH. The mean patient age was 57 years, and 60 % were male. The average width of the defect was 7.6 cm and the overall defect size averaged 56 cm². Seventeen patients (28 %) had had previous LIH repair. Ten patients had double hernia locations (midline and lateral) repaired simultaneously. The average operative time and hospital stay were 136 min and 7 days, respectively. The early complications rate was 18 %. Four patients required reoperation. There were no mesh infections. The median follow-up was 47 months (range: 1–125 months). Recurrence was observed in three patients (4.9 %).


LIH repair by RMA with a polyester heavyweight mesh proves to be a safe treatment with a moderate complication rate and a low infection rate, even in the treatment of large or multifocal parietal defects.


  1. 1.
    Iannitti DA, Hope WW, Norton HJ et al (2008) Technique and outcomes of abdominal incisional hernia repair using a synthetic composite mesh: a report of 455 cases. J Am Coll Surg 206:83–88PubMedCrossRefGoogle Scholar
  2. 2.
    Gleysteen JJ (2009) Mesh-reinforced ventral hernia repair: preference for 2 techniques. Arch Surg 144:740–745PubMedCrossRefGoogle Scholar
  3. 3.
    Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414PubMedCrossRefGoogle Scholar
  4. 4.
    Greenall MJ, Evans M, Pollock AV (1980) Midline or transverse laparotomy? A random controlled clinical trial. Part I: influence on healing. Br J Surg 67:188–190PubMedCrossRefGoogle Scholar
  5. 5.
    Kendall SW, Brennan TG, Guillou PJ (1991) Suture length to wound length ratio and the integrity of midline and lateral paramedian incisions. Br J Surg 78:705–707PubMedCrossRefGoogle Scholar
  6. 6.
    Halm JA, Lip H, Schmitz PI et al (2009) Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision. Hernia 13:275–280PubMedCrossRefGoogle Scholar
  7. 7.
    Ferrari GC, Miranda A, Sansonna F et al (2009) Laparoscopic repair of incisional hernias located on the abdominal borders: a retrospective critical review. Surg Laparosc Endosc Percutan Tech 19:348–352PubMedCrossRefGoogle Scholar
  8. 8.
    Morrison CP, Wemyss-Holden SA, Iswariah H et al (2002) Lateral laparoscopic port sites should all be closed: the incisional “spigelian” hernia. Surg Endosc 16:1364PubMedCrossRefGoogle Scholar
  9. 9.
    Moreno-Egea A, Carrillo A, Aguayo JL (2008) Midline versus nonmidline laparoscopic incisional hernioplasty: a comparative study. Surg Endosc 22:744–749PubMedCrossRefGoogle Scholar
  10. 10.
    Stumpf M, Conze J, Prescher A et al (2009) The lateral incisional hernia: anatomical considerations for a standardized retromuscular sublay repair. Hernia 13:293–297PubMedCrossRefGoogle Scholar
  11. 11.
    Langer S, Christiansen J (1985) Long-term results after incisional hernia repair. Acta Chir Scand 151:217–219PubMedGoogle Scholar
  12. 12.
    Luijendijk RW, Hop WC, van den Tol MP et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398PubMedCrossRefGoogle Scholar
  13. 13.
    Sauerland S, Walgenbach M, Habermalz B et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 3:CD007781PubMedGoogle Scholar
  14. 14.
    Gurusamy KS, Samraj K (2007) Wound drains after incisional hernia repair. Cochrane Database Syst Rev: CD005570Google Scholar
  15. 15.
    White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64:276–280PubMedGoogle Scholar
  16. 16.
    Poghosyan T, Veyrie N, Corigliano N et al (2012) Retromuscular mesh repair of midline incisional hernia with polyester standard mesh: monocentric experience of 261 consecutive patients with a 5-year follow-up. World J Surg 36:782–790. doi: 10.1007/s00268-012-1443-1 discussion 791–782PubMedCrossRefGoogle Scholar
  17. 17.
    Pessaux P, Msika S, Atalla D et al (2003) Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients. Arch Surg 138:314–324PubMedCrossRefGoogle Scholar
  18. 18.
    Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89:534–545PubMedCrossRefGoogle Scholar
  19. 19.
    Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71PubMedCrossRefGoogle Scholar
  20. 20.
    Takagi H, Sugimoto M, Kato T et al (2007) Postoperative incision hernia in patients with abdominal aortic aneurysm and aortoiliac occlusive disease: a systematic review. Eur J Vasc Endovasc Surg 33:177–181PubMedCrossRefGoogle Scholar
  21. 21.
    Welty G, Klinge U, Klosterhalfen B et al (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5:142–147PubMedCrossRefGoogle Scholar
  22. 22.
    Weyhe D, Belyaev O, Muller C et al (2007) Improving outcomes in hernia repair by the use of light meshes—a comparison of different implant constructions based on a critical appraisal of the literature. World J Surg 31:234–244. doi: 10.1007/s00268-006-0123-4 PubMedCrossRefGoogle Scholar
  23. 23.
    Schmidbauer S, Ladurner R, Hallfeldt KK et al (2005) Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res 10:247–253PubMedGoogle Scholar
  24. 24.
    Junge K, Klinge U, Rosch R et al (2007) Improved collagen type I/III ratio at the interface of gentamicin-supplemented polyvinylidenfluoride mesh materials. Langenbecks Arch Surg 392:465–471PubMedCrossRefGoogle Scholar
  25. 25.
    den Hartog D, Dur AH, Tuinebreijer WE et al. (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev: CD006438Google Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Nicolas Veyrie
    • 1
  • Tigran Poghosyan
    • 1
  • Nicola Corigliano
    • 1
  • Guillaume Canard
    • 1
  • Stephane Servajean
    • 1
  • Jean-Luc Bouillot
    • 1
  1. 1.Department of General, Digestive and Metabolic Surgery, Ambroise Paré Teaching HospitalUniversité Versailles Saint-Quentin, Assistance Publique - Hôpitaux de ParisBoulogneFrance

Personalised recommendations