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Retromuscular mesh and hernial sac technique in the reconstruction of 139 cases of large median incisional hernias: one institution’s experience

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Incisional hernia is the most common complication of laparotomy. Postoperative parietal defects tend to relapse, even after the most optimal surgical methods. The aim of this study was to present the effectiveness of an adapted retromuscular technique with prolene mesh and a hernial sac, in patients with large incisional median hernias. The reported results were obtained by our team after more than 15 years of experience.


This retrospective study included 139 consecutive cases of large median incisional hernias operated on using a retromuscular mesh and hernial sac technique. The cross-sectional diameter of incisional hernias was larger than 10 cm, being classified in the W3 group, according to the European Hernia Society classification.


The study included 83 females (59.71%) and 56 males (40.29%) with a median age of 62.4 ± 16.6 years and an average body mass index of 32.4 ± 7.6 kg. The hernia was supraumbilically located in 54 cases, subumbilically in 61 cases, and supra- and subumbilically in 24 cases. Postoperative complications were recorded in eight cases (5.75%): one case with a hematoma in the right abdominal muscle sheath; five cases with supra-aponeurotic seromas; two cases with skin necrosis and one with a mesh infection. Recurrence occurred in seven cases (5.03%): four cases in the first 2 years postoperatively and three cases in the third year after surgery.


The retromuscular technique with prolene mesh and a hernial sac is an effective method of restoring the integrity of the abdominal wall in large median incisional hernias with low rates of morbidity and recurrence.

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This work was supported by a grant of the Romanian National Authority for Scientific Research, CNCS–UEFISCDI, project number 20 PCCF/2018, code: PN-III-P4-ID-PCCF-2016-0006.

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Correspondence to S. Gurzu.

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Conflict of interest

TJB declares no conflict of interest; SG declares no conflict of interest; CB declares no conflict of interest; MM declares no conflict of interest; IJ declares no conflict of interest; ZF declares no conflict of interest; TB declares no conflict of interest.

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The University of Medicine and Pharmacy of Targu Mures, Romania Institutional Review Board reviewed and approved this study.

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The study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all patients prior to all surgical procedures.

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Bara, T., Gurzu, S., Borz, C. et al. Retromuscular mesh and hernial sac technique in the reconstruction of 139 cases of large median incisional hernias: one institution’s experience. Hernia 24, 99–105 (2020). https://doi.org/10.1007/s10029-019-01915-x

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  • Incisional hernia
  • Prolene
  • Retromuscular
  • Hernial sac