Die Onlay-Technik in der Hernienchirurgie der Narbenhernie

Abstract

Onlay Technique in Hernia Surgery of Incisional Hernia In hernia surgery, treating the scar without a mesh leads to a high recurrence rate. The latter could be markedly reduced by the use of mesh prostheses. In hernias of the ventral abdominal wall, we mainly applied the onlay technique; from 1995 to 2002 we treated 107 patients by using a polypropylene mesh for reinforcement in the anterior rectus sheath. Hernias measuring 3–25 cm were reinforced longitudinally with mesh; the mean size of the hernial opening was 120 cm². No intraoperative complications were observed. Immediately after operation, 10 patients (9.3%) developed a wound infection. In 2 patients the mesh had to be removed because of the wound infection; the remaining 8 patients could be treated conservatively with antibiotics. The minimum observation period was 1 year. On average the patients were followed up 4.2 years postoperatively. A total of 83 patients (77.6%) were followed 9 (8.4%) of whom developed a recurrence. One patient had chronic pain in the operation site since the mesh had been inserted. This patient had age-related depression before surgery. After the operation, his symptoms were focused on the abdominal wall. Our results confirm the onlay technique a good procedure for incisional hernia repair – a simple surgical technique with a low recurrence rate. However, the superficial position of the prosthesis proved to be a disadvantage; it led to a high infection rate. In a few cases the infected prosthesis had to be removed. In prospective randomized studies, the onlay technique should be compared with other surgical procedures for the treatment of hernias of the ventral abdominal wall, namely the sublay technique, the reinforced tension line technique, and laparoscopic methods. These studies will reveal the optimum surgical procedure for the treatment of ventral hernias according to their size and mesh ruptures as well as the best treatment for particularly large hernias.