Compound repair of intraperitoneal onlay mesh associated with the sublay technique for giant lower ventral hernia

Large lower ventral hernias are defined as defects located from 3-cm above the symphysis pubis to the umbilicus, and are larger than 10 cm in diameter. Surgical repair of these hernias is challenging because of the large defect, enormous hernia contents, a narrowed abdominal cavity, and close proximity to bony and vascular structures. This study aimed to evaluate a novel repair technique with a combination of intraperitoneal onlay mesh and the Rives-Stoppa technique for these hernias.

Clinical data of 26 consecutive patients with large lower ventral hernias from 2008 to 2010 were reviewed. Gradually, the hernia contents were reduced into the abdominal cavity and an abdominal binder was applied from 2 weeks preoperatively. At the same time, vesical pressure was monitored by instilling normal saline into the bladder through a Foley catheter. Compound repair using intraperitoneal onlay mesh associated with the Rives-Stoppa technique was undertaken in all these patients.

Fifteen males and 11 females were included, with a mean age of 55.5±13.2 years and a mean body mass index of 27.8±4.5 kg/m. Vesical pressure under 20 cm H2O was achieved preoperatively. Mean hernia size was 112.5±33.5 cm, with a mean polypropylene mesh size of 120.4±40.2 cm and a mean compound mesh size of 220.8±76.6 cm. The mean operative time was 155.5±38.2 minutes and the hospital stay was 12.0±3.5 days. Twenty-six patients had a mean follow-up period of 14.5±6.5 months. One iatrogenic bladder injury occurred because of an obscure prevesical space secondary to a previous mesh repair. Four patients had seromas, 3 had chronic pain, and 1 had superficial infection, with no presentation of abdominal compartment syndrome. No recurrence was observed at follow-up.

Compound repair of intraperitoneal onlay mesh associated with the Rives-Stoppa technique is a safe and efficient surgical procedure for large lower ventral hernia. Both perioperative management and operative technology play important roles in management of large lower ventral hernia.