Abstract
Introduction: In publications on ventral incisional hernia repair, the Chevrel technique and the onlay operation are often equated. This present review now aims to present the difference between these surgical techniques and analyze the findings available on the Chevrel technique.Materials and Methods: A systematic search of the available literature was performed in January 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, as well as a search of relevant journals, books, and reference lists. Thirty-four publications were identified as relevant for this review. For assessment of the Chevrel-technique with other surgical procedures there are no randomized controlled trials, prospective or retrospective comparative studies available but only case series. In the majority of case series the follow-up procedure is not reported.Results: In the onlay technique the defect is closed with direct suture or it is omitted altogether. Whereas, in the Chevrel technique this is done with sliding myofascial flaps harvested from the rectus sheaths. In the few case series available this appears to result in a lower recurrence rate for the Chevrel technique compared with the onlay technique. However, the rates of postoperative complications, surgical site occurrences (SSOs), surgical site infections (SSIs), seroma, and skin necrosis are as high as in the onlay technique. The reason for this is that both techniques require subcutaneous undermining with severance of perforator vessels.Conclusion: If mesh placement in onlay position has been chosen for specific reasons, preference can be given to the Chevrel technique over the standard onlay technique, although the study quality is limited.
Highlights
In publications on ventral incisional hernia repair, the Chevrel technique and the onlay operation are often equated
This review summarizes the publications available to date for the Chevrel technique and analyzes the findings
After cleaning of the anterior rectus sheath of all adipose tissue, transverse incisions above and below are made in the sheath and these transverse incisions are connected by longitudinal incisions
Summary
In publications on ventral incisional hernia repair, the Chevrel technique and the onlay operation are often equated. Because of defect closure with sliding myofascial flaps harvested from the incised anterior layers of the rectus sheaths, Chevrel Technique in Incisional Hernia the Chevrel technique differs greatly from direct defect closure or bridging as used in the onlay technique [8, 9]. These different techniques should be clearly distinguished from each other and analyzed separately [5, 8, 9]. The historical evolution of this technique and its variations will be discussed
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