Combined fascia and mesh closure of large incisional hernias

Incisional hernias are common and recurrence after repair has been reported in up to 44% of patients. Large incisional hernias of the abdominal wall represent substantial defect of supportive tissues.

Twenty-nine patients with large incisional hernias underwent surgery from January 2003 through December 2005. Herein, we presented our experience in closure of large incisional hernias using a technique in which we combine a fascia with a prosthetic repair. The variables recorded were classified as patient-related (gender, age, obesity, cough, constipation, diabetes mellitus, glucocorticosteroid therapy, smoking habit, and abdominal surgical history) and operation-related factors (size of defect, recurrence, wound infection, hematoma, and duration of hospital stay).

The repair was performed for 25 midline hernias and four large incisional hernias in the right subcostal region. Four patients were females and 25 were males with a mean age of 52 (range: 30 - 77) years. The mean size of fascial defect was 12.7x4.5 cm. The mean time of operation was three hours and 18 minutes. The mean hospital stay was six (range: four to ten) days. Two patients had recurrence during the follow-up period. The mean follow-up period was 16 (range: eight to 26) months.

The combined three-layer fascia and mesh repair can be successfully used for large incisional hernias.