Rives-Stoppa retromuscular repair for incisional hernias

Abstract

Background: Incisional hernias are a prevalent problem in abdominal surgery and occur in 11% of patients who undergo laparotomy. Primary suture closure of an incisional hernia results in a 31- 58% recurrence and the addition of a prosthetic mesh implant decreases recurrence rates to 8%-10%. Popularized in Europe by Rives and Stoppa, the sublay technique has proven to be very effective with low recurrence rates (0-23%) and minimal complications. The purpose of the study was to evaluate the experience of a single surgeon at a large tertiary care center performing a modified Rives-Stoppa repair for abdominal incisional hernias. Materials & Methods: The records of all patients undergoing a modified Rives-Stoppa incisional hernia repair between January 2000 and August 2003 were retrospectively reviewed. Outpatient clinic notes, discharge summaries, operative reports, and laboratory data were reviewed for patient demographics, surgical data and postoperative complications. All data was collected with previous written consent of the patient and approval by the hospital institutional review board. Statistical analysis was conducted using SPSS for Windows. Results: During the study period, 83 patients underwent a modified Rives-Stoppa incisional hernia repair. Nineteen patients were excluded due to incomplete medical records. The majority of incisional hernias were midline and supraumbilical, with several (n=3) flank hernias. Forty-five percent (n=29) of the incisional hernias were recurrent (mean 2, range 1-7, S.D.± 1.6). No patient required postoperative exploration for an intra-abdominal catastrophe. Follow-up information was available for 61 patients, with mean follow-up of 20 weeks (range 1-144 weeks, S.D.± 30.1) and mean number of follow-up visits of three (range 1-13, S.D. ± 2.9). Twenty-five percent (n=16) of patients had a complication as a result of the hernia repair. Six patients (9.4%) had superficial wound or deep mesh infections. None required removal of the prosthetic mesh and were successfully managed with antibiotics and/or drainage. One patient suffered a reaction to staples, four (6.3%) developed seromas, and three developed (4.7%) hematomas. Four patients (6.3%) were noted to have early postoperative small bowel obstructions and all of these were successfully managed conservatively. Only two patients (3.1%) developed recurrent incisional hernias. Conclusions: The results presented here confirm that the modified Rives-Stoppa retromuscular repair is an effective method for the repair of incisional hernias. The complication and recurrence rates compare favorably to published results for alternative techniques.