Novel Technique (Woven Darning Method) in the Management of Large Midline Incisional Hernias

Abstract

Ventral hernia repair has been a challenge to the surgeons from time immemorial. To do a tension free repair is our goal and prevention of recurrence is our aim especially in incisional hernias with large defect. Many techniques like Anatomical repair, Keel’s repair and Mayo’s double breasting etc. have been developed. These techniques are not adequate in the management of midline incisional hernias with large defects. Abrahamson developed a technique of creation of a new linea alba using the anterior rectus sheath and a Shoelace like polypropylene darning to reinforce the gaps at the lateral cut edge of the rectus sheath. After that a modification was advocated by fixing a polypropylene mesh to the lateral cut edges. Still the theoretical possibility of the gaps is there, moreover there is enormous fibrous tissue reaction with mesh contracture along with the chance of infection. With this background in mind, we advocate a novel technique of reinforcing the rectus sheath gap with a scaffold of two layered polypropylene darning in a woven pattern. In this technique, the usage of large quantity of foreign material (polypropylene mesh) is avoided. At the same time, adequate reinforcement is obtained with no recurrence so far, in our study