[A pathogenetic approach to the surgical treatment of large postoperative hernias]

Intractable intraoperative retraction of the abdominal musculature, associated with large postoperative hernias, give rise to reduced abdominal cavity volume, increase of intra-abdominal pressure and pulling along the suture line. These are factors considered as preconditions of the development of postoperative complications and recurrences. Experience with intraoperative facilitation by the application of relief incisions on the aponeurosis of the external oblique abdominal muscles according to Borodin et al during restoration of the abdominal wall continuity at the site of defect is shared. The procedure described is used in the operative management of ten patients presenting large postoperative hernias following superior median laparotomy, in two of them recurrent, one female patient following Rio Branco's operative access, and two cases with recurrent hernia after appendectomy. A complication--operative wound hematoma--is recorded in a single female patient only. The uneventful postoperative course, and the absence of recurrences over periods ranging from several months to two years, are good reasons to discuss the experience so far accumulated, and recommend the method for the practice.