Repair of large abdominal incisional hernia by reconstructing the midline and use of an onlay of biological material.

BACKGROUND: The aim of this study was to determine the feasibility and efficacy of repairing large abdominal incisional hernias by reconstructing the midline using bilateral abdominis rectus muscle sheath (ARS) relaxing incisions and a biological material onlay.

METHODS: Between January 2002 and December 2008, 71 patients underwent repair of large incisional hernias at 2 community hospitals. After replacement of hernia sac contents into the peritoneal cavity, a relaxing incision was made in the ARS bilaterally. Then, the midline was closed primarily. The biological material was used as an onlay and sutured to the lateral edges of the relaxed ARS. Main outcome measures were postoperative complications and hernia recurrence.

RESULTS: Median defect size was 195 cm(2) (range, 150-420 cm(2)), median surgical time was 125 minutes, and median hospital stay was 6 days. There were no deaths and no wound infections. Wound seroma, the most frequent postoperative complication, occurred in 51 (72%) of the 71 patients. There was 1 (1.4%) recurrence.

CONCLUSIONS: In these 71 patients, our technique for repair of large abdominal incisional hernias was safe and effective.