A simple stapling technique for prosthetic repair of massive incisional hernias

This article introduces a simpler, faster, and safer method of performing the Stoppa procedure with an articulating stapler. It also encourages use of preperitoneal repair instead of the often unsuccessful onlay mesh repair. The latter repair involves placing the mesh over the abdominal aponeurotic layer and can result in a high incidence of infection, seroma accumulation, and chronic fibrous cyst formation. In the preperitoneal repair technique, the same force that created the hernia--the intraabdominal hydrostatic pressure--keeps the mesh tightly in place and prevents recurrence of the hernia. The authors base their recommendation of the stapling technique on the experience of 54 large incisional hernias successfully repaired by preperitoneal insertion of a large sheet of Marlex mesh (Stoppa's procedure). In 29 of the 54 patients, the mesh was fixed in place with hand suturing. In the other 25, articulating staplers attached the mesh. The authors have found the stapling technique to be both simpler to accomplish and safer for the patient.