Practical experience with the Stoppa repair of ventral/incisional hernias

Although there are several surgical techniques to repair ventral/incisional hernias, these recur as often as 50% of the time. We have reviewed our experience with a wide, preperitoneal inlay of a conforming mesh (the Stoppa repair) in the management of more difficult ventral/incisional hernias.

Retrospective chart review of all patients receiving ventral/incisional hernia repair at our institution between 29 December 1993 and 20 May 1998. Charts were analyzed for prior ventral/incisional hernia repairs, and risk factors for recurrence (morbid obesity, prior mesh infections, and asthma/chronic obstructive pulmonary disease). Follow-up was obtained through outpatient chart reviews and phone calls.

There were 76 repairs in 67 patients. The mean length of hospital stay was 5.08 days (4.38 days primary, 5.3 days mesh, 5.5 days Stoppa). The mean length of operation time was 164 minutes (131 minutes primary, 141 minutes mesh, 231 minutes Stoppa). Forty-one percent of the patients who underwent a Stoppa repair had one or more risk factors for recurrence and 50% (mean of 1.9 prior repairs per patient) of the patients had prior repairs, compared to 26% and 36% (mean of 1.4 prior repairs per patient) for mesh patch repairs, and 33% and 21% (mean of 1 prior repair per patient) for primary repairs. The crude recurrence rates were 43.5% for primary repairs, 19.2% for mesh repairs, and 18.2% for Stoppa repairs.

The Stoppa repair appears to be an effective technique for particularly complex ventral/incisional hernia repairs. In such repairs it achieves a recurrence rate comparable to that achieved by other mesh techniques for less complex hernias.