[Large eventrations: deep extensive cleavage of the abdominal wall and prosthetic repair]

The objective for surgical repair of major defects of the abdominal wall is an anatomical reconstruction and reinforcement with a support prosthesis. Wall reconstruction should be obtained without tension. This requires deep extensive cleavage so the deep musculo-aponevrosis can be advanced approximately 10 cm. This manoeuvre is anatomic and preserves vascularization and innervation. A prosthesis covers the orificies and reinforces the anatomic construction. In peripheral defects, cleavage is necessary for closure. The prosthesis is anchored on deep solid structures (ribs, iliac crests) guaranteeing solidity. In a series of 252 operated patients, abdominal wall solidity was achieved in 91% of the cases with a mean follow-up of 2 to 13 years. Mortality was 1.2% and morbidity 8%, emphasizing the importance of rigorous indications. Intensive preparation including the Goni Moreno pneumoperitoneum is required for surgery in all major abdominal wall defects.