[Overview and evolving strategies of ventral hernia repair]

Incisional hernias occur in 5-10% of patients who have undergone laparotomy and are associated with high morbidity and significant socioeconomic costs. Techniques for reinforcing and/or replacing the abdominal wall with alloplastic meshes have reduced the recurrence rate in comparison to suture techniques from about 40% to less than 10%. A number of mesh types and surgical repair procedures are available, namely the onlay, inlay, sublay, underlay, and intraperitoneal onlay mesh (IPOM) techniques. Evolving strategies include precise criteria for incorporating patient body type, risk factors for recurrence, hernia morphology, and the available biomaterials into the planning of the surgical approach. The authors herein present an overview of the current surgical trends, focusing on mesh reinforcement (sublay technique) and mesh replacement (IPOM technique). Additionally, they review a classification of incisional hernias that is self-explanatory, practicable in routine clinical practice, and based on the cornerstones of morphology, hernia size, and risk factors for recurrence. Evidence for the indications and limitations of the main surgical repair techniques are illustrated and discussed.