Page 175 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Discussion
Recurrence rate
This review on surgical repair of LIH shows better long-term recurrence rates and hazards for techniques with mesh reinforcement compared to techniques without mesh reinforcement. To exemplify this nding, it was discovered that mesh reinforced CST and aponeuroplasty reported lower recurrence rates compared to their conventional use and implementation without mesh reinforcement. These results are comparable to the repair of small and medium sized IH (17, 19).
The best recurrence rates and hazards for LIH repair were reported after sandwich technique, sublay repair and aponeuroplasty with IPOM. After several years of follow-up the recurrence rates of these techniques were 3.6% or lower. These exceptional low recurrence rates were even lower than reported recurrence rates of 9-14% for small hernias repaired with sublay or intraperitoneal mesh as reinforcement(18). This might partially be explained by the experience of surgeons who published these series on LIH(10, 49, 50). Due to the complexity of problem we believe that patients with a LIH should only be operated by experienced hernia surgeons. In case of mesh repair, the sublay technique might be the best option for LIH repair as it is already widely implemented and displayed good recurrence rates and hazards. The mesh can be positioned in the sublay position after closing the posterior rectus sheaths or after the sandwich technique, which uses a part of the hernia sac as an extension of the posterior rectus sheath to create an extraperitoneal (sublay) space for the mesh. Although the hernia sac seems not as strong as the anterior or posterior rectus sheath, results of the sandwich technique seem promising. The aponeuroplasty technique is only described by one group and is currently not widely used. However, mesh repair might not be possible because of complex abdominal wall anatomy due to brosis, and/or co-morbidities such as obesity, pulmonary disease and old age. These cases should be treated case by case, and the best option might be conservative treatment.
Mortality
In the included studies the postoperative mortality of LIH repairs varied between 0.4% and 10.4%. Mortality was not associated with the used technique of repair. However, in patients with a simple LIH overall mortality
8
Review treatment large IH
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