Giant midline abdominal incisional herniae repair through combined retro-rectus mesh placement and components separation: experience from a single centre

Abstract

Giant midline abdominal wall incisional herniae require repair/reconstruction to restore the structural and functional continuity of the anterior abdominal wall. We describe here our approach to these demanding cases through a combined retro-rectus mesh placement and components separation and their overall functional outcome. A retrospective analysis of a prospectively collected data was carried out and 28 patients who underwent giant (≥15cm) midline incisional hernia reconstruction were identified in a large district general hospital between 2007 and 2013 with a median follow-up of 34 (6-76)months. Demographic data of our series include age of 60 (median) (30-87)years with a M:F ratio of 12:16, length of symptomatic hernia 18 (median) (12-36)months, more than two previous laparotomies (15), bowel obstructive symptoms (7) and recurrent herniation (7). BMI recorded was 32 (median) (24-46) and ASA of II (median) (I-III). Co-morbidities included cardiac disease (6), diabetes (6), respiratory disease (4) and systemic immunocompromise (2). Operative and technical details showed operative duration to be 180 (median)min, cranio-caudal rectus sheath defect 21 (median)cm, transverse rectus sheath defect 15 (median)cm, cross-sectional area of fascial defect 300 (median)cm(2) and size of mesh 690 (median)cm(2). Seven (25%) developed short-term post operative complications: grade I seromata all resolving spontaneously (5); grade II superficial wound infections (2). Twenty-five (89%) were completely asymptomatic at 34 (median)months' follow-up; 2 (7%) reported mild pain, but not limiting any activity; 1 (4%) described pain occasionally limiting activity. There was no clinical recurrence with one patient developing global bulging. Our series is comparable to the literature in patient cohort demographics, co-morbidity and risk factor profile; however, we demonstrate an excellent intermediate term outcome with no clinical recurrence and an improvement in quality of life, through their ability to perform normal day to day activities.