Evaluation of Double Mesh Modification of Chevrel’s Technique in Management of Midline Incisional Hernia

Hazem Nour,Mohamed Farid,Hany Mohamed

doi:10.4314/aas.v18i1.4

Abstract

Background: Chevrel’s technique provides tensionfree repair of midline incisional hernia, but wide skin and subcutaneous dissection increases rate of complications. Here, we evaluate the double mesh modification of Chevrel’s technique in midline incisional hernia repair. Methods: 22 patients with midline incisional hernia underwent double mesh modification of Chevrel’s technique. After excision of hernial sac with minimal dissection of the skin and subcutaneous tissue, the anterior rectus sheath is incised on both sides to create medial flaps that are sutured toeach other. Both recti abdominis muscles were dissected off the posterior rectus sheath, opening the retrorectus space. Prolene mesh was fixed in the retrorectus space with prolene sutures, and tailored to cover the bare area of anterior surface of both recti muscles and fixed to the lateral flaps of the anterior rectus sheath with interrupted prolene sutures. Results: We observed no recurrences, no skin necrosis, two cases of seroma, one case of superficial wound infection and one case of temporarychronic pain. Conclusion: Double mesh modification of Chevrel technique is an efficient method for treatment of midline incisional hernia, with minimal surgical site occurrences. Keywords: Chevrel technique, Double mesh technique, Midline incisional hernia

Highlights

Incisional hernia represents the most frequent late complication of abdominal surgery, occurring in 2–23% of all laparotomies, representing about 10% of all abdominal hernias [1,2]
The follow-up period ranged between 7 and 31 months, with mean follow up time 23.4±7.8 months. By this period there was no recurrence or skin necrosis but we encountered seroma in two patients, which resolved within 2 weeks after two times aspiration and suction drain removal
Superficial wound infection occurred in one patient which resolved with conservative measures, while chronic pain occurred in one patient and disappeared after 6 months, and corsage feeling occurred in one patient and disappeared after 5 months (Table 3)

Summary

Introduction

Incisional hernia represents the most frequent late complication of abdominal surgery, occurring in 2–23% of all laparotomies, representing about 10% of all abdominal hernias [1,2]. Sublay position is frequently used in combination with other repairs such as the (endoscopic) anterior or posterior component separation technique [15,16] These techniques require dissection beyond the lateral border of the rectus muscles, increasing the risk of damage to the perforating epigastric arteries and nerves, wound complications and bulging of the lateral abdominal wall [15,16,17]. Chevrel’s technique provides tensionfree repair of midline incisional hernia, but wide skin and subcutaneous dissection increases rate of complications. After excision of hernial sac with minimal dissection of the skin and subcutaneous tissue, the anterior rectus sheath is incised on both sides to create medial flaps that are sutured to each other Both recti abdominis muscles were dissected off the posterior rectus sheath, opening the retrorectus space. Conclusion: Double mesh modification of Chevrel technique is an efficient method for treatment of midline incisional hernia, with minimal surgical site occurrences

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Results

Conclusion