Page 168 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 8
Figure 3. Aponeuroplasty technique; incising both anterior rectus sheaths and suturing them overlapping together. A mesh can additionally be implanted intraperitoneally (IPOM) (red dotted line) or onlay (blue dotted line).
c) Langenskiöld method
In 1982 Smitten et al published the results of the ‘Langenskiöld’ method of hernia repair, using strips of the hernial sac passed through the opposite abdominal wall as pulling threads to approximate the rectus muscles in the midline(38). Disappointing results included wound infection in one third of all patients and 20 out of the 46 patients (44%) with LIH developed a recurrence after a mean follow-up of 6 years.
2. Open reconstruction with mesh
a) Open repair with sublay mesh (Rives-Stoppa technique)
French surgeons pioneered the use of a synthetic mesh in LIH repair performing closure of the rectus fascia using the preperitoneal (Stoppa, 1973) or retromuscular plane (Rives, 1973) ( gure 4) (84, 85). In 11 articles a total of 762 LIH were repaired using the sublay technique.(10, 39-48). Currently sublay repair consists of dissection and closure of the posterior rectus sheath and placement of a non-absorbable mesh. Most authors report no problems with closing the posterior rectus sheath after dissecting the retrorectus plane. In a large hernia the defect can extend into the subumbilical abdominal wall (below the arcuate line) where no posterior rectus sheath is present and the mesh is (partly) positioned in the preperitoneal plane. Rosen extends the retromuscular dissection by incising the posterior rectus sheet just medial of the semilunar line and positioning the mesh in the retromuscular plain and more laterally in the preperitoneal plain (between the peritoneum and the transvers abdominis muscle)(47). In 26% of cases, patients had a complex LIH. Since not all studies
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