Repair of complex incisional hernias using double prosthetic repair: single-surgeon experience with 50 cases

The treatment of complex incisional hernias is still difficult and controversial. With technologic developments we can modify and update the operative techniques described for treating complex abdominal wall hernias.

This is a prospective study of 50 patients with complex incisional hernias undergoing complex abdominal wall herniorrhaphy at a university hospital. All patients were evaluated in a multidisciplinary clinic dedicated to abdominal wall reconstruction. All patients underwent pre-operative computed tomography. Complex incisional hernias were regarded as those with multiple recurrences (>3 times), a previous mesh complicated by fistula and chronic infection, giant diffuse lumbar hernias, an associated parastomal hernia, or hernias developing after bariatric surgery. The operative technique was a double reconstruction prosthetic mesh. The type of repair as well as clinical, operative, and follow-up data were analyzed.

Eight patients had considerable loss of tissue, 5 had trophic skin lesions, and 2 had chronic suppurative infection. The mean size of the defects was 18.2 cm. Morbidity included 5 cases of seroma, 2 neuralgias, and 2 cutaneous necroses. The mean duration of hospital stay was 5 days (range, 2-9). Complete follow-up (mean, 48 months; range, 12-108) showed no recurrent hernias.

While awaiting a longer follow-up to confirm the results, we conclude that complex incisional hernias can be repaired safely and with a low morbidity and recurrence rate by means of a double prosthetic repair technique.