[Abdominal cicatricial hernia--results of various surgical techniques]

Incisional hernias and recurrent hernias are frequent after abdominal operations. We studied possible reasons for the occurrence of recurrent hernia. From 1986 to 1990, 150 patients were operated for recurrent hernia in the St. Claraspital Basel. After a mean follow up of 5 years, 125 patients (83.3%) were evaluated. The recurrence rate of hernias--mostly first recurrences--was 19.2%; two thirds occurred in the first 24 months after operation. The time between the primary repair of the incisional hernia and the first recurrence was 23.1 months, between first and second recurrence 15.8 months and between second and third recurrence 12 months. Patients operated by a consultant showed a lower recurrence rate (16.6%) than patients operated by residents (30.4%). In primary hernias, repaired by a simple direct closure, a recurrence rate of 23.2% was observed and after a second or third operation even one of 50%. After implantation of a non-resorbable mesh, this rate was 12.5% of 14.3%, respectively. The recurrence rate was independent of the size of the defect. As result of our investigation, we would recommend to repair recurrent hernias by inserting a non-resorbable mesh by experienced operators.