Comment to: A modified Chevrel technique for ventral hernia repair: long-term results of a single centre cohort. Mommers EHH, Leenders, B.J.M., Leclercq, W.K.G. et al.
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We read with great interest the recent article by Mommers , published in hernia. The authors reported favorable ventral hernia repair results with the modified Chevrel technique. Although various techniques have been described in the repair of ventral/incisional hernias, including onlay techniques and various sublay techniques, the ideal location of mesh placement remains heavily debated . This debate very much resembles that of Lichtenstein technique vs preperitoneal repair in inguinal hernias. And similarly, both onlay and sublay techniques will play a role in ventral hernia repair. And no surprise, again, the debate will go on, since no one is perfect. The major concerns on the onlay mesh repair are the wide creation of the lipocutaneous flaps and potential wound complication. Thus, the present modified Chevrel technique seems a reasonable alterative to the original Chevrel technique. Although promising results were obtained from the author’s present modified Chevrel technique, some points are needed to pay attention. First, the recurrence risk after ventral hernia repair depends largely on the extent of mesh overlap, despite of the mesh location. The modified Chevrel technique has the inherit limitation in sufficient overlap, since the mesh border within the lateral border of the rectus fascia, especially in large hernia defect, and this is no problem in sublay technique, e.g., with the transversus abdominis muscle release (TAR) technique . The second point is the “meticulous suturing”, which the author stressed that it will take “approximated 2 h” to complete. I would like to emphasize again the tenet that, the suture fixation could never substitute sufficient overlay in prosthesis-based hernia repair. Thus, in this point, I would question the necessity of the time-consuming suturing step, is it a compensation for the insufficient overlap, or a lack of confidence for this modification? Again, it is the overlap that matters, in spite of the mesh location, in the ventral hernia repair.
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