Page 172 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 8
f ) The sandwich technique
In the ‘sandwich technique’ the hernia sac is used as an extension of the posterior rectus sheath and the anterior rectus sheath. A non-absorbable mesh is implanted in the sublay position to reinforce the repair ( gure 6). In 5 studies a total of 131 LIH were repaired using the sandwich technique(53, 70-73). In approximately 10% a complex LIH was present.
Postoperative complications of wound infection and seroma were reported in respectively 17% and 5% of simple LIH. One patient developed necrosis of both fascia and skin which led to mesh exposure and necessitated mesh explantation(73). In the small group of patients with complex LIH, no postoperative complications were reported. After a follow-up of 1 to 7 years, the only recurrence reported after the sandwich technique was of the patient needing mesh explantation.
Figure 6. The ‘sandwich technique; a) half of the hernial sac (red) is used as an extension of the posterior rectus sheath and the contralateral half of the hernial sac as an extension of the anterior rectus sheath. b) A mesh is placed in retromuscular position (blue dotted line).
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