Treatment Of Large Incisional Hernias Research Articles

P-038 BOTULINUM TOXIN IN THE TREATMENT OF COMPLEX ABDOMINAL HERNIAS: A REVIEW OF CLINICAL OUTCOMES

Abstract Aim Adjuvant use of botulinum toxin (BTX), which causes temporary paralysis of the lateral abdominal wall muscles, may have a roll in achieving a functional abdominal wall reconstruction when treating complex hernias, without the need of component separation techniques (CST). Methods Retrospective analysis of all patients with complex hernia between April 2021 and October 2022 in which BTX was used. Patients that would have to go through CST regardless and patients with other adjuvant treatments were excluded. Results 22 patients had BTX, with a total of 13 patients included in this study. The median age was 64 and BMI 30,7kg/m2. The average CT imaging measurement of the transverse defect was 13,7cm. The median of Cedar's calculation was 27%. 7 patients (54%) only needed a Rives Stoppa Wantz (RSW) for midline closure, but 6 patients still needed a CST. The median time of the surgery for the RSW was 233 min and for the CST 330 min. Of the patients submitted to RSW, 1 complicated with a deep incisional infection and 2 CST patients had surgical complications. No recurrences in the RSW group and one hernia persistence after a major complication on the CST group. Conclusion The BTX can have an important role as an adjuvant in the treatment of large incisional hernias and in some patients may allow its repair with a less invasive surgical technique, with less operative time and less complications. More studies are needed in this area.

Comparison of Surgical Treatment Results of Large Incisional Hernias.

Introduction Incisional hernias are one of the most common complications after abdominal surgery. Surgical repairs of large incisional herniashave higher complications and recurrence rates compared to smallerincisional herniarepairs. For this reason, it is a more difficult and experience-requiring application for surgeons. In addition, there is no evidence-based consensus in the literature regarding the optimal surgical treatment of large incisional hernias.The aim of this study is to compare the results of the three most common surgical treatment methods used ina tertiary university hospital for the repair of large incisional hernias in terms of patients' characteristics, recurrence, and complication rates of the treatment methods. Methods Between 2014 and 2020, 366 patients with incisional hernias with facial defects larger than 10 cm in a tertiary medical faculty hospital located in eastern Turkey were analyzed.Patients were divided into three groups according to the surgical method used: open onlay prolene mesh(OPM) method, laparoscopic intraperitoneal sublay dual mesh (IPSDM) method, and open IPSDM method. Postoperative complications were divided into five groups as follows: wound complications, complications due to surgical procedures, medical complications, recurrences, and mortality. Treatment methods were compared according to the demographic characteristics of the patients and the postoperative complication rates. Results Of the patients, 141 were male and 225 were female, and the mean age was 58.0 ± 28 years. Of the patients,81.9% were operated on with the open OPM, 10.9% with the laparoscopic IPSDM, and 7.1% with the open IPSDM.Wound complications occurred in 26.7% of patients, surgical complications in 3.2%, medical complications in 6.5%, recurrence in 9.2%, and mortality in 0.8% of patients.Total wound complications were significantly higher in the open OPM group (30%) (p = 0.009). Total surgery complications were significantly higher in the laparoscopic IPSDM group (15%) (p = 0.002). There was no significant difference between groups for medical complications (p = 0.540). Although no recurrence was observed in the open IPSDM group, no significant difference was observed between the groups(p = 0.099). There was no difference in mortality rates between the groups (p = 0.450). The overall complication rate was highest in the open OPM group (48.3%) and lowest in the open IPSDM group (27%) (p = 0.092).The operative time was found to be significantly shorter in open IPSDM (p < 0.001). The length of hospital stay was highest in the open OPM group and lowest in the open IPSDM group (p = 0.450). Conclusions Although hernia defect is greater in the open IPSDM compared to other methods, this method is more advantageous in terms of the complication rate associated with the surgical procedure, the overall complication rate, the duration of surgery, and the recurrence rate. Laparoscopic IPSDM is a more advantageous method in terms of the overall wound and medical complications.

The outcome of pre-operative botulinum toxin in the treatment of large incisional hernias

Large incisional hernias with loss of domain represents a challenge for the surgeon. Pre-operative tools such as progressive pneumoperitoneum or botulinum toxin type A have been reported as useful tools for effective and successful surgical procedure in patients with large incisional hernias. Both the mentioned procedures are complementary to hernia repair, using no-strain mesh techniques that support patients’ integral management. The objective of current investigation was to assess the potential of pre-operative botulinum toxin in the treatment of large incisional hernias. Thirteen patients with large incisional hernias were investigated and examined for different parameters including diameters of the abdominal cavity and hernia sac, volume of the contents of incisional hernia and volume of the abdominal cavity which were calculated from CT scan. The current investigation was carried for a duration of two years from December 2020 and January 2022. After thorough clinical examination patients were operated for ventral incisional hernia repair. Eleven patients underwent complete repair of abdominal wall; one patient underwent mesh bridging and one patient required onlay repair. Botulinum toxin was observed to be a safe technique, which has good patient tolerance and can constitute as an effective preoperative tool in the treatment of large incisional hernia. This technique was observed to be aidful in significantly reducing the hernia content into the abdominal cavity, which in turn is an important factor in the treatment of large incisional hernia.

Robotic hernia repairIII. English version : Robotic incisional hernia repair with transversus abdominis release (r‑TAR). Video report and results of acohort study.

The principle of targeted separation or weakening of individual components of the abdominal wall to relieve tension in the median line during major abdominal reconstruction has been known for over 30 years as anterior component separation (aCS) and is an established procedure. In search of alternatives with lower complication rates, posterior component separation (pCS) was developed; transversus abdominis release (TAR) is a nerve-sparing modification of pCS. With the ergonomic resources of robotics (e.g., angled instruments), TAR can be performed in a minimally invasive manner (r-TAR): hernia gaps of up to 14 cm can be closed and a large extraperitoneal mesh implanted. In this video article, the treatment of large incisional hernias using the r‑TAR technique is presented. Exemplary results of a cohort study in 13 consecutive patients are presented. The procedure is challenging, but our own results—as well as reports from the literature—are encouraging. The r‑TAR is becoming the pinnacle procedure for abdominal wall reconstruction.Supplementary InformationThe online version of this article (10.1007/s00104-021-01500-y) includes a video and an intraoperative checklist.

Robotic hernia repair : PartIII: Robotic incisional hernia repair with transversus abdominis release (r-TAR). Video report and results of a cohort study

Das Prinzip der gezielten Trennung bzw. Schwächung einzelner Komponenten der Bauchdecke zur Spannungsentlastung der Medianlinie bei großen abdominellen Rekonstruktionen ist seit über 30 Jahren als anteriore Komponentenseparation (aKS) bekannt und ein etabliertes Verfahren. Auf der Suche nach Alternativen mit geringerer Komplikationsrate wurde die posteriore Komponentenseparation (pKS) entwickelt; der „transversus abdominis release“ (TAR) ist eine nervenschonende Modifikation der pKS. Mit den ergonomischen Ressourcen der Robotik (z. B. abgewinkelte Instrumente) kann der TAR minimal-invasiv durchgeführt werden (r-TAR): Bruchlücken von bis zu 14 cm lassen sich verschließen und ein großes extraperitoneales Netz implantieren. In diesem Videobeitrag wird die Versorgung großer Inzisionalhernien in der r‑TAR-Technik präsentiert. Exemplarisch werden die Ergebnisse einer Kohortenstudie an 13 konsekutiven Patienten vorgestellt. Der Eingriff ist anspruchsvoll, die eigenen Ergebnisse sind – wie auch die Berichte aus der Literatur – ermutigend. Der r‑TAR entwickelt sich zur Königsdisziplin der Bauchdeckenrekonstruktion.Zusatzmaterial onlineDie Onlineversion dieses Beitrags (10.1007/s00104-021-01480-z) enthält ein Video und eine intraoperative Checkliste.

Preoperative Botulinum Toxin and Progressive Pneumoperitoneum are Useful in the Treatment of Large Incisional Hernias

Preoperative Botulinum Toxin and Progressive Pneumoperitoneum are Useful in the Treatment of Large Incisional Hernias

Treatment of Large Incisional Hernias in Sandwich Technique - A Review of the Literature.

IntroductionIn a systematic review of the surgical treatment of large incisional hernia sublay repair, the sandwich technique and aponeuroplasty with intraperitoneal mesh displayed the best results. In this systematic review only the sandwich technique, which used the hernia sac as an extension of the posterior and anterior rectus sheath and placement of a non-absorbable mesh in the sublay position, was included. Other modifications of the sandwich technique are published in the literature and were also analyzed in this literature review.MethodsA systematic search of the available literature was performed in November 2017 using Medline, PubMed, and the Cochrane Library using the terms “sandwich technique”, “double prosthetic repair”, “double mesh intraperitoneal repair”, and “component separation technique with double mesh”. This review is based on 24 relevant publications. Unfortunately, the evidence of the available studies is not very high since only prospective and retrospective case series have been published. There are no comparative studies at all. Therefore, the findings of the published case series must be viewed in a critical light.ResultsThe published studies report a remarkably low recurrence rate of 0-13% with a follow-up of 1–7 years. One limitation that must be mentioned here is that in around half of the studies the method of follow-up was not specified and in the remaining cases this was based on clinical examination by the surgical team. This puts into perspective the reported results, which appear to be too favorable given the complex nature of the hernias involved.The major disadvantage of the sandwich technique is a very high rate of wound complications of up to 68%, mainly induced by creation of large skin and subcutaneous cellular tissue flaps.ConclusionIt is difficult to evaluate the significance of the various modifications of the “sandwich technique” based on the available literature since it includes only case series and no comparative studies. The techniques used are associated with very high wound complication rates but with only relatively low recurrence rates despite the complexity of the cases involved. This must be verified in studies with a well-designed methodology.

Laparoscopic intraperitoneal onlay mesh for pediatric incisional hernia\u2014a case report

BackgroundThe incidence of incisional hernia in pediatric patients is low in comparison with that reported in adults. In the pediatric population, primary closure has generally been favored. However, synthetic or biomedical mesh offers advantages in the repair of larger defects when primary closure is difficult. The use of laparoscopic intraperitoneal onlay mesh (IPOM) in the adult population has been well documented. In the pediatric population, a few laparoscopic approaches with direct suturing have been proposed; however, there are no reports of laparoscopic repair with the use of IPOM.Case presentationThe patient was a 1-year-old girl with epigastric incisional hernia after an operation to correct a complete arteriovenous septal defect. The fascial defect (size 30 × 35 mm) was large; thus, direct suturing was considered to be associated with a high risk of thoracic deformation and recurrence.Laparoscopic IPOM was performed. The fascial defect was detected precisely through the laparoscopy, and non-absorbable mesh was placed through a 12-mm trocar. Minimal incisions were required for the trocars, and extensive dissection of the abdominal wall structure was not needed. This procedure allowed for the integrity and functional status of the abdominal wall to be maintained.ConclusionLaparoscopic IPOM is a minimally invasive and cosmetically acceptable method that can be applied to the treatment of large incisional hernias in children.

Surgical treatment of large incisional hernias with intraperitoneal composite mesh: a cohort study.

Patients with large incisional hernias have significant morbidity and their management is a challenge for the surgical team because of the large abdominal wall involvement. The choice of surgical technique is still controversial. The purpose of this study is to analyze the predictive factors for recurrence after intraperitoneal mesh repair in patients with large incisional hernias. A retrospective cohort observational study with a prospectively collected database was performed in the Hospital Clinico San Carlos (Madrid, Spain). All consecutive patients operated on from January 2009 to December 2014 with incisional hernia of 10 or more centimeters in its transverse diameter were included. An intraperitoneal repair with a composite mesh fixed with discontinuous absorbable suture and fibrin sealant was performed. Demographic data, comorbidities, and early and long term outcomes were analyzed. The primary outcome was the presence of recurrence. One hundred and twenty patients were included. Mean age was 63.3years (SD 12.9) and sex ratio was 1.4:1. Seventy-two patients (60%) were ASA III-IV. Forty-five patients (37.5%) had recurrent ventral hernias. Mean defect size was 14.7cm (SD 3.21) of width. Overall postoperative morbidity rate was 25%. Median hospital stay was 6days (IQR 4-8). Recurrence rate was 8.3%, after a median follow-up of 16months (IQR 10-25). Multivariate analysis showed significant association between ASA III-IV, use of Composix Kugel™ mesh, superficial surgical site infection, and the presence of recurrence. The recurrence rate after intraperitoneal mesh repair in patients with large incisional hernias might be associated with ASA III-IV, use of Composix Kugel™ mesh, and superficial surgical site infection.

Surgical treatment of large incisional hernia

Treatment of large incisional hernia (LIH) is still a challenge to most of the abdominal wall surgeons. Mesh reinforcement is essential for treatment of LIH, component separation technique(CST) provides significant assistances for the close of abdominal wall defect. The use of mesh reinforcement with CST during LIH repair displayed the best results. Understanding and choosing the correct procedure is very important for LIH repair which significantly decreases both the recurrence rate and morbidity postoperatively after LIH repair.

Reply to Comment to: A systematic review of the surgical treatment of large incisional hernia. T. Georgiev-Hristov, A. Celdrán. Hernia 2015; 19:89-101.

We thank Tihomir Georgiev-Hristov and Angel Celdran for their comment on our review on the surgical treatment of large incisional hernias. The authors suggest a double-mesh technique for the closure of large incisional hernias. The results of our review are in line with their statement that the use of a mesh reduces the recurrence rate. The use of two meshes in different planes of the abdominal wall is an interesting concept. However, as they describe in their comment, all articles on ‘double mesh’ techniques advocate a different surgical repair. Meshes are placed in different planes of the abdominal wall, some techniques are bridging, others insist on midline closure, even applying additional releases or component separation techniques. The varying techniques make it different to compare outcomes and complication rates. We would like to encourage a high-quality cohort study with a clearly described double-mesh technique to make the results of this technique comparable to the techniques reported in our review.

Comment to: A systematic review of the surgical treatment of large incisional hernia. Deerenberg EB, Timmermans L, Hogerzeil DP, Slieker JC, Eilers PH, Jeekel J, Lange JF. Hernia 2015; 19:89-101.

Comment to: A systematic review of the surgical treatment of large incisional hernia. Deerenberg EB, Timmermans L, Hogerzeil DP, Slieker JC, Eilers PH, Jeekel J, Lange JF. Hernia 2015; 19:89-101.

Continuous Local Analgesia in Postoperative Treatment of Large Incisional Hernias – Preliminary Results

Abstract Background: The incisional hernias are frequent complications after laparotomy. Extended subcutaneous tissue dissection is often necessary for the treatment of large incisional hernias, and this procedure is frequently followed by a high intensity pain in the postoperative period. The aim of this study was to assess the postoperative patient comfort without using major analgesics. Material and method: we present the preliminary results of an ongoing study from Surgery Clinic 1 of Emergency Clinical County Hospital of Târgu Mures, University of Medicine and Pharmacy Târgu Mures. The study comprises in the intraoperative insertion of a subcutaneous catheter (Pajunk InfiltraLong) placed on lay, through which we administered continuously Ropivacaine 0,5%. Results: Ten patients have been included in the study by now. For 5 of the patients the wound infiltration was started with 7 ml/h in the first 6 postoperative hours, after which the rate decreased to 5 ml/h until the end of the 72 hours, when the catheter was removed. For 2 patients the wound infiltration was started with 10ml/h in the first 6 postoperative hours, after which the rate decreased to 7 ml/h in the first day, followed by 5 ml/h for the next two days. Two patients needed a minor analgesic in the immediate postoperative period and one patient needed major analgesia in the first 24 hours. Conclusions: By using this method, postoperative analgesia can be achieved without using major systemic analgesics and a superior patient comfort can be achieved simply by adjusting the infusion rate

A systematic review of the surgical treatment of large incisional hernia.

Incisional hernia (IH) is one of the most frequent postoperative complications. Of all patients undergoing IH repair, a vast amount have a hernia which can be defined as a large incisional hernia (LIH). The aim of this study is to identify the preferred technique for LIH repair. A systematic review of the literature was performed and studies describing patients with IH with a diameter of 10 cm or a surface of 100 cm2 or more were included. Recurrence hazards per year were calculated for all techniques using a generalized linear model. Fifty-five articles were included, containing 3,945 LIH repairs. Mesh reinforced techniques displayed better recurrence rates and hazards than techniques without mesh reinforcement. Of all the mesh techniques, sublay repair, sandwich technique with sublay mesh and aponeuroplasty with intraperitoneal mesh displayed the best results (recurrence rates of <3.6%, recurrence hazard <0.5% per year). Wound complications were frequent and most often seen after complex LIH repair. The use of mesh during LIH repair displayed the best recurrence rates and hazards. If possible mesh in sublay position should be used in cases of LIH repair.

Peritoneal volume is predictive of tension-free fascia closure of large incisional hernias with loss of domain: a prospective study

The surgical treatment of large incisional hernias with loss of domain (LIHLD) carries the risk of fascia closure under tension and, thus, abdominal compartment syndrome. We investigated volume measurements as a predictive factor for tension-free fascia closure. From September 2004 to July 2008, we prospectively included 17 patients with LIHLD. The operation was prepared by a progressive preoperative pneumoperitoneum (PPP) technique known as the Goni Moreno procedure. The patient's age and body mass index (BMI), the incisional hernia's width, length and surface area, and the incisional hernia volume (IHV)/peritoneal volume (PV) ratio <20% were evaluated as predictive factors for tension-free fascia closure. A tension-free closure was defined as a closure in which the use of a surgical device for avoiding postoperative compartment syndrome was not required. The mean PPP volume introduced was 12.7±4.4l (range 4.5-19.2) over a period of 11±6days (range 4-24). The mean width, height and surface area of the incisional hernia after PPP were 11.3±4.7cm (range 4.5-19), 13.4±7.8cm (range 4.4-30) and 165±101cm(2) (range 19-304), respectively. The mean IHV after PPP was 2,374±1,356cc (range 517-4,802) and the mean abdominal cavity volume was 9,558±4,106cc (range 4,785-21,782). The mean IHV/PV ratio was 16.3±10.4% (range 4.4-34). In a univariate analysis, the BMI and the IHV/PV ratio were predictive of tension-free fascia closure. In a multivariate analysis, only an IHV/PV ratio <20% was a significant predictive factor. The IHV/PV ratio is predictive of tension-free fascia closure for hernias or incisional hernias with loss of domain. Simplification of the volumetry method is necessary.

Surgical treatment of large incisional hernias by intraperitoneal insertion of Parietex® composite mesh with an associated aponeurotic graft (280 cases)

To evaluate post-operative complications and the recurrence rate after repair of large ventral incisional hernia with an open technique using intraperitoneal composite mesh and an associated aponeurotic overlay. This prospective study included a total of 280patients who underwent repair of large incisional hernia using Parietex(®) composite mesh. The post-operative mortality rate was 0.35%. Six patients (2%) developed subcutaneous surgical site infection without infection of the prosthesis. Six other patients (2%) developed a deep-seated infection; in three cases, the mesh had to be removed. Nine patients (3.2%) developed recurrent incisional hernia. Large ventral incisional hernias can be effectively treated by the intraperitoneal placement of Parietex(®) composite mesh overlaid by an aponeurotic graft; the incidence of complications in this prospective study was very low.

A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain

Preoperative progressive pneumoperitoneum (PPP) is a safe and effective procedure in the treatment of large incisional hernia (size > 10 cm in width or length) with loss of domain (LIHLD). There is no consensus in the literature on the amount of gas that must be insufflated in a PPP program or even how long it should be maintained. We describe a technique for calculating the hernia sac volume (HSV) and abdominal cavity volume (ACV) based on abdominal computerized tomography (ACT) scanning that eliminates the need for subjective criteria for inclusion in a PPP program and shows the amount of gas that must be insufflated into the abdominal cavity in the PPP program. Our technique is indicated for all patients with large or recurrent incisional hernias evaluated by a senior surgeon with suspected LIHLD. We reviewed our experience from 2001 to 2008 of 23 consecutive hernia surgical procedures of LIHLD undergoing preoperative evaluation with CT scanning and PPP. An ACT was required in all patients with suspected LIHLD in order to determine HSV and ACV. The PPP was performed only if the volume ratio HSV/ACV (VR = HSV/ACV) was >or=25% (VR >or= 25%). We have performed this procedure on 23 patients, with a mean age of 55.6 years (range 31-83). There were 16 women and 7 men with an average age of 55.6 years (range 31-83), and a mean BMI of 38.5 kg/m(2) (range 23-55.2). Almost all patients (21 of 23 patients-91.30%) were overweight; 43.5% (10 patients) were severely obese (obese class III). The mean calculated volumes for ACV and HSV were 9,410 ml (range 6,060-19,230 ml) and 4,500 ml (range 1,850-6,600 ml), respectively. The PPP is performed by permanent catheter placed in a minor surgical procedure. The total amount of CO(2) insufflated ranged from 2,000 to 7,000 ml (mean 4,000 ml). Patients required a mean of 10 PPP sessions (range 4-18) to achieve the desired volume of gas (that is the same volume that was calculated for the hernia sac). Since PPP sessions were performed once a day, 4-18 days were needed for preoperative preparation with PPP. The mean VR was 36% (ranged from 26 to 73%). We conclude that ACT provides objective data for volume calculation of both hernia sac and abdominal cavity and also for estimation of the volume of gas that should be insufflated into the abdominal cavity in PPP.

A tension-free technique for the repair of large incisional hernias during abdominal surgery: Results and long-term outcome

Purpose. The optimal treatment for ventral hernias during abdominal surgery has yet to be defined. The objective of this study was to evaluate the outcome of a modified prosthetic technique for the treatment of large incisional hernias performed as a step following intra-abdominal surgery. Methods. Between January 1990 and December 2000, ninety-nine consecutive patients who underwent abdominal surgery for different causes received surgical repair for large incisional hernia with a modified mesh technique consisting of a tension free attachment of the prosthetic material to the posterior sheath of the rectus muscle. Surgical outcome was assessed mainly as recurrence rate for the abdominal hernia and postoperative complications. Results. Abdominal surgery varied from simple gynaecologic surgery up to advanced oncologic surgery. Eleven patients (11,11%) presented minor complications and 6 patients (6,06%) suffered major complications. There was one postoperative death and 3 patients (3,03%) presented recurrence of incisional hernia. Post operative hospital stay was 6,3 days (± 2,3 days). Conclusions. This study encourages the use of a tension-free, modified prosthetic technique for the repair of large incisional hernia during operation for abdominal pathology, which doesn’t lead to an increase in the incidence of complications, offering considerable advantage for the patient.

Surgical treatment of large incisional hernias by an intraperitoneal Dacron mesh and an aponeurotic graft.

The therapeutic problems of giant incisional hernias of the abdominal wall are difficult to resolve. The technique of repair must make up for the loss of abdominal wall substance and reestablish the interplay of the abdominal musculature. The use of prosthetic materials complies with these two imperatives. The aim of this prospective study was to evaluate the results of surgical treatment of postoperative incisional hernias by intraperitoneal insertion of Dacron (DuPont) mesh and an aponeurotic graft. We prospectively studied 350 consecutive patients who were operated on for giant postoperative incisional hernia. Postoperative mortality was 0.6%. Seven patients (2%) developed subcutaneous infections that did not affect the prostheses. Another seven patients (2%) developed deep-seated infections that necessitated removal of the mesh in five cases. Eleven patients (3.1%) had recurrence of incisional hernia. This prospective study shows that the intraperitoneal positioning of Dacron mesh and an aponeurotic graft can efficiently treat giant abdominal wall hernias.

Éventrations postopératoires: prothèse intraou extrapéritonéale?

Study aim The aim of this retrospective study concerning the repair of postoperative incisional hernia using Dacron mesh was to compare results according to the extraor intraperitoneal mesh position in order to assess the respective indications of each option. Materials and methods From January 1985 to December 1996, 172 patients (mean age: 61.3 years) were operated on using Dacron mesh extraperitoneally ( n = 99) or intraperitoneally located ( n = 73). For statistical analysis, both groups were compared using Chi square test or Fisher's test. Results There were no postoperative deaths in the group with extraperitoneal mesh and two postoperative deaths in the group with intraperitoneal mesh. There were no significant differences when results comparing parietal complications (sepsis: 2% vs 2.7%, pain: 9.1% vs 16.9%), secondary intestinal disorders (2% vs 4.2%) and recurrence rate (4% vs 5.6%) were assessed between extraperitoneal and intraperitoneal mesh. Recurrences were related to parietal infection treated by partial removal of the mesh ( n = 2) or to the lateral detachment of the mesh ( n = 6). Conclusions In the group of patients receiving extraperitoneal mesh there were no postoperative deaths and morbidity was low (this technique is generally used in the treatment of large incisional hernia). In the group of patients receiving intraperitoneal mesh, similar parietal and general complications were observed. But the risk of serious complications and postoperative death is higher; this technique must be limited to the most serious incisional hernia and to high risk patients.