[Ventral herniotomy. Development of surgical technique and effect on the frequency of recurrence]

The surgical journal, Repair of Ventral Hernias, was reviewed with regard to recurrence of hernia. Ventral hernias must be operated on with a tension-free technique. It is recommended that hernias larger than 4 cm are repaired with mesh. A randomised, controlled trial has yet to be carried out to determine whether even small hernias should be repaired with mesh. Controlled and uncontrolled studies have shown that the use of mesh to repair larger hernias results in a lower recurrence rate. The operative technique with the mesh placed to bridge the wall defect gives a higher rate of recurrence than does an overlap technique. The overlap of the mesh and its placement in relation to the different layers of abdominal wall are not defined. The laparoscopic operation using the overlap technique and intraperitoneal mesh has shown a lower recurrence rate than the open technique. However, a randomised, controlled study comparing the laparoscopic and open overlap technique over a long follow-up period still needs to be conducted.