Operative treatment of massive ventral hernia using polypropylene mesh: a challenge for surgeon and anesthesiologist

Surgical repair of very large ventral hernias has become feasible after the introduction of synthetic meshes and developments in intensive-care treatment. In addition to the operative challenges, postoperative disorders in the cardiovascular system, tissue oxygenation, increased intra-abdominal pressure, and pulmonary embolism expose the patient to severe risks.

From 1997-2002 we operated on ten patients with giant ventral incisional or umbilical hernia (mean defect size 240 cm(2)) by using retromuscular polypropylene mesh. All patients were morbidly obese [mean Body Mass Index (BMI) 39+/-7.2 kg/m(2)]. Four of the operations were emergencies because of an acute intestinal occlusion, bowel gangrene, and skin complications. The patients were reinvestigated after the mean follow-up of 2.5 years to find out the frequency of recurrence and degree of disability.

There was no intraoperative mortality, but one patient died at home after 5 weeks because of myocardial infarct and prolonged wound infection. She had mild stable coronary heart disease preoperatively. Although minor wound complications were observed in three patients, there was no need to remove the meshes. One small recurrent hernia was observed in the follow-up, but it was too small to be repaired. The quality of life after surgery was good for all patients, and they were satisfied with the operation. Retromuscular mesh hernioplasty associated with careful patient monitoring in intensive care is safe and feasible in the selected patients with massive ventral hernia.