[Retromuscular alloplasty of large scar hernias: a simple staple attachment technique]

This article introduces a stapling technique which is a simpler, faster and safer method of performing the Stoppa procedure. 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 intra-abdominal hydrostatic pressure--keeps the mesh tightly in place and prevents recurrence of the hernia. In 29 of the 75 patients, the mesh was fixed in place with hand suturing. In the other 46, staplers attached the mesh. The authors have found the stapling technique to be both simpler to accomplish and safer for the patient.