Major abdominal wall defects remain a highly morbid complication. Occasionally a fascial defect is encountered, that despite all surgical efforts, is unable to completely approximate at the midline. Here we describe our method and outcomes of using a bridging mesh when the posterior fascia was unable to be approximated during the repair of large postoperative ventral hernias using the modified Rives-Stoppa technique.
Methods
A retrospective review was conducted looking at all the open abdominal wall hernia repairs between 2014 and 2020. The cohort of patients who had a bridge placed in addition to the traditional open modified Rives-Stoppa repair were used for this study.
Results
Nineteen patients had a mesh inlay bridge placed in addition to a modified Rives-Stoppa repair with a sublay (retrorectus) Ultrapro mesh. For the inlay mesh 13 Symbotex composite meshes were placed and 6 Vicryl meshes used. The average surface area of the defect was 358.1 cm^2. The average length of hospitalization was 8.8 days with a range of 3-24 days. During the immediate postoperative course there were 6 minor complications. During the follow-up period there were 2 recurrences.
Discussion
The use of inlay mesh bridge as an adjuvant to a modified Rives-Stoppa repair with a sublay ultrapro mesh is an effective technique for difficult abdominal wall repairs where the posterior fascia is unable to be approximated without tension.
Get full access to this article
View all access options for this article.
References
1.
LichtensteinILShulmanAGAmidPKMontllorMM. The tension-free hernioplasty. Am J Surg. 1989;157(2):188-193.
2.
AmidPK. Lichtenstein tension-free hernioplasty: Its inception, evolution, and principles. Hernia. 2004;8(1):1-7.
3.
WeisslerJMLanniMATecceMG, et al.Chemical component separation: A systematic review and meta-analysis of botulinum toxin for management of ventral hernia. J Plast Surg Hand Surg. 2017;51(5):366-374.
4.
EuckerDZerzASteinemannDC. Abdominal wall expanding system obviates the need for lateral release in giant incisional hernia and laparostoma. Surg Innovat. 2017;24(5):455-461.
5.
CarrJA. Tissue expander-assisted ventral hernia repair for the skin-grafted damage control abdomen. World J Surg. 2014;38(4):782-787.
6.
DicoccoJMFabianTCEmmettKP, et al.Components separation for abdominal wall reconstruction: The Memphis modification. Surgery. 2012;151(1):118-125.
7.
BlatnikJJinJRosenM. Abdominal hernia repair with bridging acellular dermal matrix—an expensive hernia sac. Am J Surg. 2008;196(1):47-50.
8.
KumarSEdmundsRWDowdyC, et al.Anterior versus posterior component separation: Which is better?Plast Reconstr Surg. 2018;142(3S):47S-53S.
9.
RhemtullaIAFischerJP. Retromuscular sublay technique for ventral hernia repair. InSeminars in plastic surgery. Thieme Medical Publishers. 2018;32(03):120-126.
10.
IqbalCWPhamTHJosephA, et al.Long-term outcome of 254 complex incisional hernia repairs using the modified rives-stoppa technique. World J Surg. 2007;31(12):2398-2404.
11.
MamanDGreenwaldDKreniskeJ, et al.Modified rives-stoppa technique for repair of complex incisional hernias in 59 patients. Ann Plast Surg. 2012;68(2):190-193.
12.
SakorafasGSarrMG. Repair of ventral and incisional hernias using modifications of the rives-stoppa technique. Probl Gen Surg. 2002;19(4):51-58.
13.
NevoNGoldsteinALYakubovskyO, et al.How-we-do-it: The repair of postoperative ventral hernias after a Mercedes abdominal incision. Langenbeck’ Arch Surg. 2021;15:1-7.
14.
NovitskyYWElliottHLOrensteinSBRosenMJ. Transversus abdominis muscle release: A novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204(5):709-716.
15.
ZolinSJFafajAKrpataDM. Transversus abdominis release (TAR): What are the real indications and where is the limit?Hernia. 2020;24(2):333-340.
16.
DeerenbergEBShaoJMElhageSA, et al.Preoperative botulinum toxin a injection in complex abdominal wall reconstruction–a propensity-scored matched study. Am J Surg. 2021;13:638-642.
17.
LiangMKBergerRLLiLT, et al.Outcomes of laparoscopic vs open repair of primary ventral hernias. JAMA surgery. 2013;148(11):1043-1048.
18.
ChristophersenCFonnesSAndresenKRosenbergJ. Lower recurrence rate after groin and primary ventral hernia repair performed by high-volume surgeons: A systematic review. Hernia. 2021;6:1-9.
19.
HodgkinsonJDLeoCAMaedaY, et al.A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias. Hernia. 2018;22(4):617-626.
20.
Bueno-LledóJTorregrosaAJiménez-RosellónR, et al.Predictors of hernia recurrence after rives-stoppa repair in the treatment of incisional hernias: A retrospective cohort. Surg Endosc. 2019;33(9):2934-2940.
21.
MuseTOZwischenbergerBAMillerMT, et al.Outcomes after ventral hernia repair using the rives-stoppa, endoscopic, and open component separation techniques. Am Surg. 2018;84(3):433-437.
22.
SeilerCBaumannPKienleP, et al.A randomised, multi-centre, prospective, double blind pilot-study to evaluate safety and efficacy of the non-absorbable Optilene® Mesh elastic versus the partly absorbable ultrapro® mesh for incisional hernia repair. BMC Surg. 2010;10(1):1-7.
23.
BurgerJWHalmJAWijsmullerARTen RaaSJeekelJ. Evaluation of new prosthetic meshes for ventral hernia repair. Surgical Endoscopy and Other Interventional Techniques. 2006;20(8):1320-1325.
24.
EllisHHeddleR. Closure of the abdominal wound. J R Soc Med. 1979;72(1):17-18.
25.
RamirezOMRuasEDellonAL. Components separation” method for closure of abdominal-wall defects: An anatomic and clinical study. Plast Reconstr Surg. 1990;86(3):519-526.
26.
DienerMKVossSJensenKBüchlerMWSeilerCM. Elective midline laparotomy closure: The Inline systematic review and meta-analysis. Annals of surgery. 2010;251(5):843-856.
27.
MuysomsFEAntoniouSABuryK, et al.European hernia society guidelines on the closure of abdominal wall incisions. Hernia. 2015;19(1):1-24.
28.
DeerenbergEBHarlaarJJSteyerbergEW, et al.Small bites versus large bites for closure of abdominal midline incisions (STITCH): A double-blind, multicentre, randomised controlled trial. Lancet. 2015;386(10000):1254-1260.
29.
CahalaneMShapiroMSilenW. Abdominal incision: Decision or indecision?Lancet. 1989;333(8630):146-148.
30.
HughTBNankivellCMeagherAPLiB. Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds?World J Surg. 1990;14(2):231-233.
31.
MajumderAMartin-del-CampoLAMillerHJ, et al.Evaluation of anterior versus posterior component separation for hernia repair in a cadaveric model. Surg Endosc. 2020;34(6):2682-2689.
32.
WarraichSLovegroveRGuyR. Abdominal wall reconstruction with biological mesh: novel reinforcement with mesh ‘off-cuts. Ann R Coll Surg Engl. 2014;96(8):623-624.
33.
CavallaroAMenzoELDi VitaM, et al.Use of biological meshes for abdominal wall reconstruction in highly contaminated fields. World J Gastroenterol: WJG. 2010;16(15):1928.
34.
TottenCFDavenportDLWardNDRothJS. Cost of ventral hernia repair using biologic or synthetic mesh. J Surg Res. 2016;203(2):459-465.
35.
MajumderAWinderJSWenY, et al.Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surgery. 2016;160(4):828-838.
