[Full-thickness replacement using intraperitoneal mesh in large incisional hernia].

Area of Science:

• General Surgery
• Abdominal Wall Reconstruction

Context:

• Incisional hernias present varied challenges, from simple defects amenable to primary repair to complex cases requiring advanced techniques.
• Traditional methods like simple closure (parieto-suture) are insufficient for large or complex parietal defects.

Purpose:

• To review surgical techniques for incisional hernia repair, focusing on the selection and placement of prosthesis mesh for complex defects.
• To discuss the advantages and disadvantages of different mesh implantation strategies, including extra/retro-muscular onlay and full-thickness replacement.

Summary:

• Parieto-suture techniques are suitable for most incisional hernias, but prosthesis mesh is recommended for large or complex defects.
• Extra/retro-muscular onlay mesh placement offers better vascularization than fascial onlay and is preferred when anatomic closure is possible.
• Full-thickness mesh replacement may be necessary for large defects to restore parietal competence, with low complication rates but requires measures to prevent enterocutaneous fistulas.

Impact:

• This review provides insights into optimizing mesh selection and placement for incisional hernia repair, aiming to reduce recurrence and complications.
• The findings support informed decision-making in abdominal wall reconstruction, balancing efficacy with potential risks like fistula formation.