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Hernia

, Volume 11, Issue 6, pp 473–479 | Cite as

Subxiphoid incisional hernias after median sternotomy

  • J. E. Losanoff
  • M. D. Basson
  • S. Laker
  • M. Weiner
  • J. D. Webber
  • S. A. Gruber
Review

Abstract

Background

Subxiphoid incisional hernias are notoriously difficult to repair and are prone to recurrence. The few reports on subxiphoid hernia published over the last two decades have not fully addressed the etiology, pathology, treatment, and outcome of this problem. This review was performed to analyze the published experience and increase the understanding of these difficult hernias.

Methods

We reviewed the extensive literature, including the Medline and Current Contents computerized database searches, and searched the available bibliographies.

Results

Seven retrospective studies of a total of 113 patients who had clinical subxiphoid hernias after median sternotomy were found. An additional surgical technique describing a modified median sternotomy preventing the hernia, and a single review article on selected technical considerations of subxiphoid ventral repair were also found.

Conclusions

The incidence of subxiphoid hernia after median sternotomy can be possibly reduced by paraxiphoid extension of the sternotomy, reinforcement near the xiphoid end of the incision, or by optimizing closure of the distal sternotomy and the linea alba. Abdominal wall reinforcement by open-mesh closure or laparoscopic transperitoneal prosthetic repair can effectively deal with the defect. Long-term outcome analyses are not yet available.

Keywords

Subxiphoid hernia Median sternotomy Hernia Mesh repair Tissue repair Laparoscopic surgery 

Notes

Acknowledgments

This material is the result of work supported with the resources and by the use of the facilities at the John D. Dingell VA Medical Center, Detroit, MI, USA.

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • J. E. Losanoff
    • 1
    • 2
    • 3
  • M. D. Basson
    • 1
    • 2
  • S. Laker
    • 2
  • M. Weiner
    • 2
  • J. D. Webber
    • 2
  • S. A. Gruber
    • 2
  1. 1.Surgical ServiceJohn D. Dingell VA Medical CenterDetroitUSA
  2. 2.Department of SurgeryWayne State UniversityDetroitUSA
  3. 3.Department of Surgery (11S)John D. Dingell VA Medical CenterDetroitUSA

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