Hernia

, Volume 11, Issue 4, pp 315–320 | Cite as

Repair of giant incisional abdominal wall hernias using open intraperitoneal mesh

  • C. Bernard
  • C. Polliand
  • L. Mutelica
  • G. Champault
Original Article

Abstract

Background

Very large and complex incisional hernias, especially those involving loss of abdominal wall, present a particular challenge to the surgeon.

Aims

The open intraperitoneal technique was used prospectively for the repair of incisional hernias in a selected group of patients with large defects, often those with major loss of abdominal wall, overweight patients, and previous failures of incisional repair.

Materials and methods

Between 1 January 1999 and 31 December 2005, out of 275 patients operated on for incisional hernia repair, 61 of them, most of whom were obese with multiorificial recurrent or giant hernias and contraindicated for laparoscopy, were treated using an open intraperitoneal mesh technique. There were 50 females and 11 males, with a mean age of 61. The median ASA score of the group was 2.3, with a mean BMI of 34 kg/m2 and a mean hernia surface of 182 cm2. Sixty-four percent of the patients had undergone one or more previous incisional hernia repairs.

Results

Mean operating time was 130 min, with an average hospital stay of 13 days. None of the patients died. Postoperative complications occurred in 21% of the patients; most of which were minor, but two cases (3.3%) developed deep abscesses requiring surgery and removal of the mesh. A recurrence rate of 5% was found after a mean follow-up of 35 months (8–88).

Conclusion

Open intraperitoneal mesh repair appears to be a good option for the treatment of complex incisional hernia (at least 10 cm in diameter or multiorificial) in obese patients contraindicated for laparoscopy.

Keywords

Giant incisional hernia Intraperitoneal mesh repair Open surgery 

References

  1. 1.
    Read RC, Yoder G (1989) Recent trends in the management of incisional herniation. Arch Surg 124:485–488PubMedGoogle Scholar
  2. 2.
    Ellis H, Gajraj H, George CD (1983) Incisional hernia: when do they occur? Br J Surg 70:290–291PubMedCrossRefGoogle Scholar
  3. 3.
    Hesselink VJ, Luijendijk RW, de Wilt JH, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176:228–234PubMedGoogle Scholar
  4. 4.
    Chrysos E, Athanasakis E, Saridaki Z, Kafetzakis A, Dimitriadou D, Koutsoumpas V, Chalkiadakis G, Xynos E, Zoras O (2000) Surgical repair of incisional ventral hernias: tension-free technique using prosthetic materials (expanded polytetrafluoroethylene Gore-tex dual mesh®). Am Surg 66:679–682PubMedGoogle Scholar
  5. 5.
    Bonnamy C, Samama G, Brefort JL, Le Roux Y, Langlois G (1999) Résultats à long terme du traitement des éventrations par prothèse nonrésorbable intrapéritonéale (149 patients). Ann Chir 53:571–576PubMedGoogle Scholar
  6. 6.
    Ohana G, Bramnik Z, Miller A, Seror D, Ariche A, Bachar Gil N, Belavsky R, Dreznik Z (2006). Treatment of large incisional abdominal wall hernias using a modified preperitoneal prosthetic mesh repair. Hernia 10:232–235PubMedCrossRefGoogle Scholar
  7. 7.
    Anthony T, Bergen PC, Kim LT, Henderson M, Fahey T, Rege RV, Turnage RH (2000) Factors affecting recurrence following incisional herniorrhaphy. World J Surg 24:95–101PubMedCrossRefGoogle Scholar
  8. 8.
    Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–85PubMedGoogle Scholar
  9. 9.
    Cobb WS, Harris JB, Lokey JS, McGill ES, Klove KL (2003) Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases. Am Surg 69:784–787PubMedGoogle Scholar
  10. 10.
    Cobb WS, Kercher KW, Matthews BD, Burns JM, Tinkham NH, Sing RF, Heniford BT (2006) Laparoscopic ventral hernia repair: a single center experience. Hernia 10:236–242PubMedCrossRefGoogle Scholar
  11. 11.
    Rives J, Pire JC, Flament JB, Palot JP, Body C (1985) Le traitement des grandes éventrations: nouvelles indications thérapeutiques à propos de 322 cas. Chirurgie 111:215–225PubMedGoogle Scholar
  12. 12.
    Sikkink CJ, Vries de Reilingh TS, Malyar AW, Jansen JA, Bleichrodt RP, van Goor H (2006) Adhesion formation and reherniation differ between meshes used for abdominal wall reconstruction. Hernia 10:218–222PubMedCrossRefGoogle Scholar
  13. 13.
    Hamy A, Pessaux P, Mucci-Hennekinne S, Radriamananjo S, Regenet N, Arnaud JP (2003) Surgical treatment of large incisional hernias by an intraperitoneal Dacron mesh and an aponeurotic graft. J Am Coll Surg 196:531–534PubMedCrossRefGoogle Scholar
  14. 14.
    Ammaturo C, Bassi G (2004) Surgical treatment of large incisional hernia with an intraperitoneal Parietex composite mesh: our preliminary experience on 26 cases. Hernia 8:242–246PubMedCrossRefGoogle Scholar
  15. 15.
    Vidovic D, Jurisic D, Franjic BD, Glavan E, Ledinsky M, Bekavac-Beslin M (2006) Factors affecting recurrence after incisional hernia repair. Hernia 10:322–325PubMedCrossRefGoogle Scholar
  16. 16.
    Arnaud JP, Cervi C, Tuech JJ, Cattan F (1997) Surgical treatment of post-operative incisional hernias by intra-peritoneal insertion of a Dacron mesh: a report on 220 cases. Hernia 1:97–99CrossRefGoogle Scholar
  17. 17.
    Becouarn G, Szmil E, Leroux C, Arnaud JP (1996) Cure chirurgicale des éventrations post opératoires par implantation intra péritonéale d’un treillis de Dacron: à propos de 160 cas opérés. J Chir 133:229–232Google Scholar
  18. 18.
    Oussoultzoglou E, Baulieux J, de la Roche E, Peyregne V, Adham M, Berthoux N, Ducerf C (1999) Cure chirurgicale des grandes éventrations par prothèse intra péritonéale: à propos d’une série de 186 patients avec un long recul. Ann Chir 53:33–40PubMedGoogle Scholar
  19. 19.
    Vrijland WW, Jeekel J, Steyerberg EW, Den Hoed PT, Bonjet HJ (2000) Intraperitoneal polypropylene mesh repair of incisional hernia is not associated with enterocutaneous fistula. Br J Surg 87:348–352PubMedCrossRefGoogle Scholar
  20. 20.
    Morin B, Bonnamy C, Maurel J, Samama G, Gignoux M (2001) Fistules intestinales tardives après implantation de prothèse pariétale abdominale. Ann Chir 126:876–880PubMedCrossRefGoogle Scholar
  21. 21.
    Chew DK, Choi LH, Rogers AM (2000) Enterocutaneous fistula 14 years after prosthetic mesh repair of a ventral incisional hernia: a life-long risk? Surgery 127:352–353PubMedCrossRefGoogle Scholar
  22. 22.
    Sugerman HJ, Kellum JM Jr, Reines HD, DeMaria EJ, Newsome HH, Lowry JW (1996) Greater risk of incisional hernia with morbidly obese than steroid dependant patients and low recurrence with pre fascial polypropylene mesh. Am J Surg 171:80–84PubMedCrossRefGoogle Scholar
  23. 23.
    Ben-Haim M, Kuriansky J, Tal R, Zmora O, Mintz Y, Rosin D, Ayalon A, Shabtai M (2002) Pitfalls and complications with laparoscopic intraperitoneal expanded polytetrafluoroethylene patch repair of postoperative ventral hernia. Surg Endosc 16:785–788PubMedCrossRefGoogle Scholar
  24. 24.
    Bellon JM, Contreras LA, Bujan J, Pascual G, Carrera-San Martin A (1999) Effect of relaparotomy through previously integrated polypropylene and polytetrafluoroethylene experimental implants in the abdominal wall. J Am Coll Surg 188:466–472PubMedCrossRefGoogle Scholar
  25. 25.
    Leblanc KA (2004) Laparoscopic incisional and ventral hernia repair: complications how to avoid and handle. Hernia 8:323–31PubMedCrossRefGoogle Scholar
  26. 26.
    Balique JG, Benchetrit S, Bouillot JL, Flament JB, Gouillat C, Jarsaillon P, Lepere M, Mantion G, Arnaud JP, Magne E, Brunetti F (2005) Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial. Hernia 9:68–74PubMedCrossRefGoogle Scholar
  27. 27.
    DeMaria EJ, Moss JM, Sugerman HJ (2000) Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia. Surg Endosc 14:326–329PubMedCrossRefGoogle Scholar
  28. 28.
    Heniford BT, Ramshaw BJ (2000) Laparoscopic ventral hernia repair: a report of 100 consecutive cases. Surg Endosc 14:419–423PubMedCrossRefGoogle Scholar
  29. 29.
    Mathonnet M, Antarieu S, Gainant A, Preux PM, Boutros-Toni F, Cubertafond P (1998) Eventrations postopératoires: prothèse intra- ou extrapéritonéale? Chirurgie 123:154–161PubMedCrossRefGoogle Scholar
  30. 30.
    Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89:534–545PubMedCrossRefGoogle Scholar
  31. 31.
    Luijendijk RW, Hop WC, van den Tol MP, deLange DC, Braaksma MM, Ijzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398PubMedCrossRefGoogle Scholar
  32. 32.
    Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8:42–46PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • C. Bernard
    • 1
  • C. Polliand
    • 1
  • L. Mutelica
    • 1
  • G. Champault
    • 1
  1. 1.Department of SurgeryUniversity Paris XIII, CHU Jean VerdierBondy CedexFrance

Personalised recommendations