[Butterfly mesh for the treatment of hernia]

Incisional hernias (IH) occur with an incidence of 2 to 11% after laparotomy and represent a huge social and economical problem. Polypropylene meshes remarkably decreased the incidence of recurrence after first repair. This paper reports a personal method that allows a strong, safe and quick replacement of the abdominal wall with a double layer of polypropylene mesh. This method is reliable for IHs bigger than 4 cm. The sac and the surrounding fascia are cleaned from fat and scarred tissue: peritoneum is dissected up to at least 3 cm all around the edges of the hernial sac and under the fascia, as far as possible. Two sheets of PM, 3 cm larger than the defect, are sutured together with non-absorbable running suture (polypropylene 2-0) from the center to 2 cm from the extremities at the bank. The inferior mesh is extended and fixed under the fascia with polypropylene mattress stitches. When the peritoneum is not present, the edges of the mesh are refolded and sutured to the fascia in order to avoid trauma to the loops. The superior mesh is sutured directly onto the fascia. Closed aspiration drainage is positioned. We performed this method on 20 IHs (from 5 to 25 cm long). At 24 months follow-up we never observed recurrence. This method is similar to abdominal wall suture, and permits tension free repair.