Page 171 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

invasive, posterior and endoscopic CST. Minimally invasive CST uses tunnel incisions for external oblique aponeurosis release(58, 59). In endoscopic CST direct access to the ventral abdominal wall is provided by using balloon dissectors and laparoscopic visualization(60). In posterior CST the posterior rectus sheath is incised just medial to the intercostals nerves, exposing the transverses abdominis muscle and a release of the transverse abdominis is performed(61). In 8 articles a total of 511 LIH were repaired using the MCST(47, 58-64). Conventional modi ed CST was performed in 339 patients, minimally invasive CST in 95 patients, endoscopic CST in 22 patients and posterior CST in 55 patients. In 57% of the patients a complex LIH was present. The mesh was positioned in sublay position in 52%(47, 59-63), in IPOM 28% (58, 61, 62), or in onlay position in 20% (62, 64). In 11.5% of all patients midline closure of the fascia was not completely achieved and the mesh was used in a partially bridging position.
Postoperative mortality was 1.8% and postoperative complications occurred in 55%. Infection or necrosis of the wound occurred in 33%, hematomas in 4%, seromas in 11%, and pulmonary complications in 16%. In one study 3 mesh infections requiring excision of part of the biological mesh were reported(62). The reported recurrence rate for LIH after MCST was 10.0% after 1-5 years follow-up.
e) Open repair with onlay mesh
In 1979 Chevrel was one of the rst who pioneered the use of a non-absorbable mesh on the anterior fascia of the rectus muscle as reinforcement of suture repair ( gure 4)(86). In 6 articles a total of 454 LIH were repaired using the onlay mesh technique(53, 65-69). In 4% a complex LIH was present. In 26 patients additional relaxing incisions were used to achieve tension-free closure of the midline(67, 68). In 38 patients the defect was bridged with the onlay mesh(53, 66).
Postoperatively no mortality was reported. Wound infection occurred in 31% of patients and removal of the mesh was required in 1.7%. Seromas developed in 19% of patients, mainly in patients with a biological mesh. Respiratory and cardiovascular complications occurred in 6%. The overall recurrence rate of LIH repair with onlay mesh was 11.1% after a 15 to 77 months follow-up.
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Review treatment large IH
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