Abstract
BackgroundRepair of large ventral hernias is challenging when primary fascial closure cannot be achieved. The peritoneal flap hernioplasty, a modification of the Rives-Stoppa retromuscular mesh repair, addresses this problem by using the hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space. It is applicable to both midline and transverse hernias. We report the results from our institution using this repair based on a retrospective review of 251 cases.MethodsPatients undergoing peritoneal flap hernioplasty repair from January 1, 2010–December 31, 2014 were identified from the Lothian Surgical Audit system, a prospectively maintained computer database of all surgical procedures in the Edinburgh region of southeast Scotland. Patient demographics, clinical presentation, location of the hernia and surgical treatment were obtained from the hospital case-notes. Follow-up consisted of a clinical consultation 3 months postoperatively and a retrospective review of patient files completed December 2018. Patients presenting signs of complications were assessed during a clinical review.ResultsTwo hundred and fifty-one patients underwent incisional hernia repair, 68.1% in the midline and 31.9% arising through transverse incisions. Forty-three of these (17%) were recurrences referred from other centers. Mean BMI was 32.1 kg/m2 (range 20–59.4 kg/m2). Mean defect width was 9.2 ± 4.2 cm (range 2.5–24.2 cm). Mean mesh size was 752 cm2 (range 150–1760 cm2). Some form of abdominoplasty was performed in 59% of cases. Mean postoperative stay was 6.3 days (range 1–33 days). Mean follow-up time was 75 months (range 44–104 months). Fifty-three patients (21.1%) developed postoperative complications. Three (1.2%) developed superficial skin necrosis and 27 (10.8%) a superficial wound infection, but none developed deep mesh infection. Twelve (4.8%) developed symptomatic seroma and 11 (4.4%) a hematoma requiring surgical intervention. Seven (2.8%) patients developed recurrence within the follow-up period.ConclusionPeritoneal flap hernioplasty is an excellent and versatile method for reconstruction of large ventral hernias arising in both midline and transverse incisions. The technique is safe and associated with few complications and a very low recurrence rate.
Highlights
The repair of primary ventral and incisional hernias is common operations [1,2,3]
Two hundred and fifty-one patients underwent incisional hernia repair, 68.1% in the midline and 31.9% arising through transverse incisions
Peritoneal flap hernioplasty is an excellent and versatile method for reconstruction of large ventral hernias arising in both midline and transverse incisions
Summary
As the width of the defect increases, obtaining original fascia-to-fascia closure without excessive tension becomes more difficult This is especially true for large ventral hernias, where primary. An alternative method to component separation for reconstruction of large abdominal wall defects is the peritoneal flap technique This method is based on the principles outlined for retromuscular mesh repair and is known as the ‘‘Swinging Door’’ or ‘‘Mesh Sandwich’’ repair. It is widely used in the UK and Europe, and series have been published by Beck [16] and Malik et al [17] It utilizes redundant tissue from the hernial sac to bridge the facial gap, and it increases abdominal domain by expending the abdominal wall at the site of herniation without inducing weakness laterally. We report the results from our institution using this repair based on a retrospective review of 251 cases
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