Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia

Abstract

Repair of incisional hernia (IH) in the elderly is a challenge for the surgeon. Primary closure is preferable but is not always possible because of high recurrence rates of IH repaired without a prosthesis and/or possible respiratory and cardiovascular complications due to extreme tension of the margins. We report our experience with underlay mesh placement in elderly patients with large IH. A total of 72 patients from January 2003 to December 2009 underwent IH repair involving placement of an intraperitoneal Gore ® DualMesh ® prosthesis. The prosthesis was first anchored at eight points in a compass rose pattern using a Gore ® suture passer and then firmly secured to the abdominal wall with a 360° internal crown running suture. Two intraoperative intestinal tears occurred during debridement and were immediately sutured. Postoperative complications included seven seromas, four hematomas, and two infections, one of which was resolved with conservative treatment while one required prosthesis removal. This surgical procedure, like laparoscopic treatment, allows the surgeon to avoid dissection of the abdominal layer and improves prosthesis adhesion with reinforcement of the incisional area near the abdominal defect. The reduction in operation time is remarkable. Despite good results in terms of safety and minimal recurrence for laparoscopy in the management of IH, the use of minimally invasive techniques for large incisional wall defects, especially in elderly patients, is still controversial and practiced by few surgeons. This open technique avoids cardiopulmonary complications arising from pneumoperitoneum in the elderly.