Skip to main content

Advertisement

SpringerLink
Log in

Revisiting the Anterior Rectus Sheath Repair for Incisional Hernia: A 10-Year Experience

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Surgeons continue to seek an incisional hernia repair technique which minimizes cost and morbidity while maximizing durability. We present a single surgeon’s experience with a technique described by N.L. Browse and J.P. Chevrel in 1979.

Methods

The Chevrel/Browse repair consists of a bilateral anterior rectus sheath release, hernia sac imbrication, bilateral rectus complex medialization, and repair reinforcement with an anterior prosthetic mesh. Data were collected on all patients who underwent herniorrhaphy between April 2003 and April 2013.

Results

A total of 123 patients underwent repair. These had undergone an average of 2.6 prior abdominal operations and 0.7 prior hernia repairs; the average defect size was 64.77 ± 86.79 cm2. Twelve patients had lateral components release in addition to release of the anterior rectus sheath to achieve midline re-approximation with minimal tension. Synthetic mesh was used in 81 % of repairs and biologic mesh in 19 %. The most common complications were seroma formation (21 %) and incisional skin breakdown (30 %); no deaths occurred. The overall recurrence rate was 5.1 %, and 7 % for the group which had follow-up greater than 36 months. Use of biologic mesh increased the rate of seroma formation compared with synthetic mesh (50 vs. 14 %, p < 0.001), but did not increase the rate of wound breakdown (36.3 vs. 29.6 %, p = 0.72).

Conclusion

This case series describes the utilization of anterior rectus sheath release and mesh placement which is anterior to the rectus muscle. Hernia recurrence and intra-abdominal complications are observed to be uncommon after repair using this technique. Future prospective randomized studies are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. den Hartog D, Dur AHM, Tuinebreijer WE et al (2011) Open surgical procedures for incisional hernias (review). Cochrane Database Syst Rev

  2. Albino FP, Patel KM, Nahabedian MY et al (2013) Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg 132:1295–1304

    Article  CAS  PubMed  Google Scholar 

  3. Rives J, Pire JC, Flament JB (1977) Traitement des eventrations Encyclopedie Medico-Chirurgicale. Elsevier, Paris, pp 40–165

    Google Scholar 

  4. Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526

    Article  CAS  PubMed  Google Scholar 

  5. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? Ann Surg 237:129–135

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gibson CL (1920) Operation for cure of large ventral, hernia. Ann Surg 72:214–217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Dixon CF (1929) Repair of incisional hernia. Surg Gynecol Obstet 48:700–701

    Google Scholar 

  8. Chevrel JP (1979) The treatment of large midline incisional hernias by “overcoat” plasty and prosthesis. Nouv Presse Med 8:695–696

    CAS  PubMed  Google Scholar 

  9. Browse NL, Hurst P (1979) Repair of long, large midline incisional hernias using reflected flaps of anterior rectus sheath reinforced with Marlex mesh. Am J Surg 138:738–739

    Article  CAS  PubMed  Google Scholar 

  10. Harth KC, Rosen MJ (2010) Endoscopic versus open component separation in complex abdominal wall reconstruction. Am J Surg 199:342–346 (discussion 346–347)

    Article  PubMed  Google Scholar 

  11. Ramirez OM, Girotto JA (2001) Closure of chronic abodminal wall defects: the components separation technique. In: Bendavid R, Abrahamson J, Arregui ME et al (eds) Abdominal wall hernias: principles and management. Springer, New York City, pp 487–496

    Chapter  Google Scholar 

  12. Licheri S, Erdas E, Pisano G et al (2008) Chevrel technique for midline incisional hernia: still an effective procedure. Hernia 12:121–126

    Article  CAS  PubMed  Google Scholar 

  13. Marchesi F, Pinna F, Cecchini S et al (2011) Prospective comparison of laparoscopic incisional ventral hernia repair and Chevrel technique. Surg Laparosc Endosc Percutan Tech 21:306–310

    Article  PubMed  Google Scholar 

  14. Korenkov M, Paul A, Sauerland S et al (2001) Classification and surgical treatment of incisional hernia. Langenbecks Arch Surg 1:65–73

    Article  Google Scholar 

  15. Forte A, Zullino A, Manfredelli S et al (2011) Rives technique is the gold stardard for incisional hernioplasty. An institutional experience. Ann Ital Chir 82:313–317

    PubMed  Google Scholar 

  16. Souza JM, Dumanian GA (2013) Routine use of bioprosthetic mesh is not necessary: a retrospective review of 100 consecutive cases of intra-abdominal midweight polypropylene mesh for ventral hernia repair. Surgery 153:393–399

    Article  PubMed  Google Scholar 

  17. Iqbal CW, Pham TH, Joseph A et al (2007) Long-term outcome of 254 complex incisional hernia repairs using the modified Rives–Stoppa technique. World J Surg 31:2398–2404. doi:10.1007/s00268-007-9260-7

    Article  PubMed  Google Scholar 

  18. Bauer JJ, Harris MT, Gorfine SR et al (2002) Rives–Stoppa procedure for repair of large incisional hernias: experience with 57 patients. Hernia 6:120–123

    Article  CAS  PubMed  Google Scholar 

  19. Petro CC, Posielski NM, Raigani S et al (2015) Risk factors for wound morbidity after open retromuscular (sublay) hernia repair. Surgery 6:1658–1668

    Article  Google Scholar 

  20. Johnson KC, Miller MT, Plymale MA et al (2016) Abdominal wall reconstruction: a comparison of totally extraperitoneal and transabdominal preperitoneal approaches. J Am Coll Surg 222:159–165

    Article  PubMed  Google Scholar 

  21. Nachiappan S, Markar S, Karthikesalingam A et al (2013) Prophylactic mesh placement in high-risk patients undergoing elective laparotomy: a systematic review. World J Surg 37:1861–1871. doi:10.1007/s00268-013-2046-1

    Article  PubMed  Google Scholar 

  22. Satterwhite TS, Miri S, Chung C et al (2012) Outcomes of complex abdominal herniorrhaphy: experience with 106 cases. Ann Plast Surg 68(4):382–388

    Article  CAS  PubMed  Google Scholar 

  23. Den Hartog D, Dur AHM, Tuinebreijer WE et al (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev (3):CD006438. doi:10.1002/14651858.CD006438.pub2

  24. Tuveri M, Tuveri A, Nicolo E (2011) Repair of large abdominal incisional hernia by reconstructing the midline and use of an onlay of biological material. Am J Surg 202:e7–e11

    Article  PubMed  Google Scholar 

  25. de Vries Reilingh TS, van Geldere D, Langenhorst B et al (2004) Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia 8:56–59

    Article  PubMed  Google Scholar 

  26. Cobb WS, Warren JA, Ewing JA et al (2015) Open retromuscular mesh repair of complex incisional hernia: predictors of wound events and recurrence. J Am Coll Surg 220:606–613

    Article  PubMed  Google Scholar 

  27. 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 791-782)

    Article  PubMed  Google Scholar 

  28. Gleysteen JJ (2009) Mesh-reinforced ventral hernia repair: preference for 2 techniques. Arch Surg 144:740–745

    Article  PubMed  Google Scholar 

  29. Chevrel JP (2001) Treatment of incisional hernias by an overlapping herniorraphy and onlay prosthetic implant. In: Bendavid R, Abrahamson J, Arregui ME et al (eds) Abdominal wall hernias: principles and management. Springer, New York City, pp 500–507

    Chapter  Google Scholar 

  30. Saulis AS, Dumanian GA (2002) Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs. Plast Reconstr Surg 109(7):2275–2280

    Article  PubMed  Google Scholar 

  31. Sosin M, Patel KM, Albino FP et al (2014) A patient-centered appraisal of outcomes following abdominal wall reconstruction: a systematic review of the current literature. Plast Reconstr Surg 133(2):408–418

    Article  CAS  PubMed  Google Scholar 

  32. Criss CN, Petro CC, Krpata DM et al (2014) Functional abdominal wall reconstruction improves core physiology and quality-of-life. Surgery 156:176–182

    Article  PubMed  Google Scholar 

  33. den Hartog D, Eker HH, Tuinebreijer WE et al (2010) Isokinetic strength of the trunk flexor muscles after surgical repair for incisional hernia. Hernia 14:243–247

    Article  Google Scholar 

  34. Johansson M, Gunnarsson U, Strigard K (2011) Different techniques for mesh application give the same abdominal muscle strength. Hernia 15:65–68

    Article  CAS  PubMed  Google Scholar 

  35. Ventral Hernia Working G, Breuing K, Butler CE et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Drs. Steven Wolf and Madhu Subramanian for their assistance during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Texas – Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8548, USA

    Erica I. Hodgman & Mark J. Watson

Authors
  1. Erica I. Hodgman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark J. Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark J. Watson.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hodgman, E.I., Watson, M.J. Revisiting the Anterior Rectus Sheath Repair for Incisional Hernia: A 10-Year Experience. World J Surg 41, 713–721 (2017). https://doi.org/10.1007/s00268-016-3774-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-016-3774-9

Keywords

Search

Navigation