Mesh repair for midline ventral hernia without lateral fixation of the mesh

The Rives-Stoppa repair is the current standard of care for the open treatment of midline ventral hernia. Transfascial, lateral fixation of the mesh has always been considered an important part of this technique. I reviewed cases of patients with a primary or recurrent midline, ventral hernia who had an open repair using the Rives-Stoppa technique with the exception of mesh fixation. Heavy weight polypropylene mesh was sutured to the midline of the posterior rectus sheath with two to three interrupted stitches. Multiple metal clips were attached to the periphery of the mesh for later identification. Physical exams and CT scans were done on all patients postoperatively to assess the integrity of the repair. From November 2008 to January 2010 13 patients had an open repair using a modified Rives-Stoppa technique. All patients had an intact repair based on physical exam and a contiguous rectus abdominis muscle layer based on CT evaluation. Lateral fixation of heavy weight polypropylene mesh is not necessary when performing a retro-muscular repair using the Rives-Stoppa technique.