Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Hernia
Published in: Hernia 1/2015

01-02-2015 | Review

A systematic review of the surgical treatment of large incisional hernia

Authors: E. B. Deerenberg, L. Timmermans, D. P. Hogerzeil, J. C. Slieker, P. H. C. Eilers, J. Jeekel, J. F. Lange

Published in: Hernia | Issue 1/2015

Login to get access

Abstract

Purpose

Incisional hernia (IH) is one of the most frequent postoperative complications. Of all patients undergoing IH repair, a vast amount have a hernia which can be defined as a large incisional hernia (LIH). The aim of this study is to identify the preferred technique for LIH repair.

Methods

A systematic review of the literature was performed and studies describing patients with IH with a diameter of 10 cm or a surface of 100 cm2 or more were included. Recurrence hazards per year were calculated for all techniques using a generalized linear model.

Results

Fifty-five articles were included, containing 3,945 LIH repairs. Mesh reinforced techniques displayed better recurrence rates and hazards than techniques without mesh reinforcement. Of all the mesh techniques, sublay repair, sandwich technique with sublay mesh and aponeuroplasty with intraperitoneal mesh displayed the best results (recurrence rates of <3.6 %, recurrence hazard <0.5 % per year). Wound complications were frequent and most often seen after complex LIH repair.

Conclusions

The use of mesh during LIH repair displayed the best recurrence rates and hazards. If possible mesh in sublay position should be used in cases of LIH repair.
Appendix
Available only for authorised users
Literature
1.
Hoer J, Lawong G, Klinge U et al (2002) Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years Einflussfaktoren der Narbenhernienentstehung. Retrospektive Untersuchung an 2.983 laparotomierten Patienten uber einen Zeitraum von 10 Jahren. Chirurg 73(5):474–480. doi:10.​1007/​s00104-002-0425-5 (published online first: epub date)CrossRefPubMed
2.
Millbourn D, Cengiz Y, Israelsson LA (2009) Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 144(11):1056–1059. doi:10.​1001/​archsurg.​2009.​189 pii 144/11/1056 (published online first: epub date)CrossRefPubMed
3.
Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72(1):70–71CrossRefPubMed
4.
Adye B, Luna G (1998) Incidence of abdominal wall hernia in aortic surgery. Am J Surg 175(5):400–402PubMed
5.
Stevick CA, Long JB, Jamasbi B et al (1988) Ventral hernia following abdominal aortic reconstruction. Am Surg 54(5):287–289PubMed
6.
de Vries Reilingh TS, Bodegom ME, van Goor H et al (2007) Autologous tissue repair of large abdominal wall defects. Br J Surg 94(7):791–803. doi:10.​1002/​bjs.​5817 (published online first: epub date)CrossRefPubMed
7.
8.
Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526CrossRefPubMed
9.
Shestak KC, Edington HJ, Johnson RR (2000) The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg 105(2):731–738 quiz 39CrossRefPubMed
10.
Rives J, Pire JC, Flament JB (1985) Reflections on large eventrations. Results of our experience (322 cases) and new therapeutic indications. Chirurgie, Memoires de l’Academie de Chirurgie 111(3):215–225
11.
de Vries Reilingh TS, van Goor H, Charbon JA et al (2007) Repair of giant midline abdominal wall hernias: “components separation technique” versus prosthetic repair: interim analysis of a randomized controlled trial. World J Surg 31(4):756–763. doi:10.​1007/​s00268-006-0502-x (published online first: epub date)CrossRefPubMed
12.
13.
Borud LJ, Grunwaldt L, Janz B et al (2007) Components separation combined with abdominal wall plication for repair of large abdominal wall hernias following bariatric surgery. Plast Reconstr Surg 119(6):1792–1798. doi:10.​1097/​01.​prs.​0000259096.​99745.​cf pii 00006534-200705000-00024 (published online first: epub date)CrossRefPubMed
14.
Hesselink VJ, Luijendijk RW, de Wilt JH et al (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176(3):228–234PubMed
15.
Oussoultzoglou E, Baulieux J, De la Roche E et al (1999) Long-term results of 186 patients with large incisional abdominal wall hernia treated by intraperitoneal mesh (Cure chirurgicale des grandes eventrations par prothese intra-peritoneale. A propos d’une serie de 186 patients avec un long recul). Ann Chir 53(1):33–40PubMed
16.
Halm JA, deWall LL, Steyerberg EW et al (2007) Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery. World J Surg 31(2):423–429. doi:10.​1007/​s00268-006-0317-9 discussion 30 (published online first: epub date)CrossRefPubMed
17.
18.
19.
Burger JW, Luijendijk RW, Hop WC et al (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240(4):578–583 pii 00000658-200410000-00003 (published online first: epub date discussion 83–85)PubMedCentralPubMed
20.
Forbes SS, Eskicioglu C, McLeod RS et al (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96(8):851–858. doi:10.​1002/​bjs.​6668 (published online first: epub date)CrossRefPubMed
21.
Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia J Hernias Abdom Wall Surg 13(4):407–414. doi:10.​1007/​s10029-009-0518-x (published online first: epub date)CrossRef
22.
Slater NJ, Montgomery A, Berrevoet F et al (2014) Criteria for definition of a complex abdominal wall hernia. Hernia J Hernias Abdom Wall Surg 18(1):7–17. doi:10.​1007/​s10029-013-1168-6 (published online first: epub date)CrossRef
23.
Dobson AJ, Barnett AG (2008) An introduction to generalized linear model, 3rd edn. CRC Press, New York
24.
Team RDC (2011) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna
25.
26.
Albanese AR (1951) (Gigantic median xipho-umbilical eventration; method for treatment) Eventracion mediana xifoumbilical gigante; metodo para su tratamiento. Rev Asoc Med Argent 65(709–710):376–378PubMed
27.
Saulis AS, Dumanian GA (2002) Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs. Plast Reconstr Surg 109(7):2275–2280 discussion 81–82CrossRefPubMed
28.
de Vries Reilingh TS, van Goor H, Rosman C et al (2003) “Components separation technique” for the repair of large abdominal wall hernias. J Am Coll Surg 196(1):32–37 pii: S1072-7515(02)01478-3 (published online first: epub date)CrossRefPubMed
29.
Espinosa-de-los-Monteros A, Dominguez I, Zamora-Valdes D et al (2013) Closure of midline contaminated and recurrent incisional hernias with components separation technique reinforced with plication of the rectus muscles. Hernia 17(1):75–79. doi:10.​1007/​s10029-012-1012-4 (published online first: epub date)CrossRefPubMed
30.
31.
32.
Welti H, Eudel F (1941) Un Procede de cure radicale des eventrations postoperatoires par auto-etalement des muscles grands droits apres incision du feuillet anterieur de leur gaine. Chirurgie, Memoires de l’Academie de Chirurgie 12:791–798
33.
Loh A, Rajkumar JS, South LM (1992) Anatomical repair of large incisional hernias. Ann R Coll Surg Engl 74(2):100–105PubMedCentralPubMed
34.
Sturniolo G, Versace GA, Gagliano E et al (1994) Actuality of the overlapping suture in the therapy of aponeurotic and incisional hernias. Chirurgie, Memoires de l’Academie de Chirurgie 120(6–7):320–324
35.
Smitten VK, Heikel HVA, Sundell B (1982) Repair of incisional hernias by F. Langenskiold’s operation. Acta Chirurgica Scandinavica 148(3):257–261
36.
Stoppa R (1973) Les plasties de la paroi abdominale. Table ronde du 75eme Congres Francais de Chirurgie. Avec la participation de R Bourgeon, Ph Detrie Cl gautier-Benoit, A Milhaud, H Neidhardt, J Poilleux, J Rives, J Visset. In: Actualites Chirurgicales, Masson Paris, pp 662–736
37.
Rives J, Lardennois B, Pire JC et al (1973) Large incisional hernias. The importance of flail abdomen and of subsequent respiratory disorders (Les grandes eventrations. Importance du “volet abdominal” et des troubles respiratoires qui lui sont secondaires). Chirurgie 99(8):547–563PubMed
38.
Berry MF, Paisley S, Low DW et al (2007) Repair of large complex recurrent incisional hernias with retromuscular mesh and panniculectomy. Am J Surg 194(2):199–204CrossRefPubMed
39.
Campanelli G, Bastazza M, Ruca A et al (2000) Surgical treatment of incisional hernias with marked loss of substance. Hernia 4(4):202–205CrossRef
40.
Fernandez Lobato R, Fernandez Luengas D, Serantes A et al (2000) Use of Histoatryl (registered trademark) for incisional hernia repair. Hernia 4(2):99–103CrossRef
41.
Heisterkamp J, den Hoed PT, Kluin J et al (2005) Long-term results after modified Gallie technique for incisional hernia repair: results in 19 patients. Hernia 9(1):12–15CrossRefPubMed
42.
Tonante A, Lo Schiavo MG, Bonanno L et al (2004) Complications of open prosthetic surgery for large incisional hernias (Le complicanze della chirurgia protesica “open” dei grandi laparoceli). Chir Ital 56(5):629–637PubMed
43.
Toniato A, Pagetta C, Bernante P et al (2002) Incisional hernia treatment with progressive pneumoperitoneum and retromuscular prosthetic hernioplasty. Langenbecks Arch Surg 387(5–6):246–248CrossRefPubMed
44.
Trivellini G, Bagni CM, Sollini A et al (2001) Repair of giant hernias using more prosthesis. Hernia 5(3):124–128CrossRefPubMed
45.
Alexandre JH, Dupin P (1983) Surgical treatment of complex abdominal wall hernias. Medecine et Chirurgie Digestives 12(6):423–426
46.
Rosen MJ, Reynolds HL, Champagne B et al (2010) A novel approach for the simultaneous repair of large midline incisional and parastomal hernias with biological mesh and retrorectus reconstruction. Am J Surg 199(3):416–420 discussion 20–11CrossRefPubMed
47.
48.
Briennon X, Lermite E, Meunier K et al (2011) Surgical treatment of large incisional hernias by intraperitoneal insertion of Parietex(R) composite mesh with an associated aponeurotic graft (280 cases). J Visc Surg 148(1):54–58CrossRefPubMed
49.
Hamy A, Pessaux P, Mucci-Hennekinne S et al (2003) Surgical treatment of large incisional hernias by an intraperitoneal Dacron mesh and an aponeurotic graft. J Am Coll Surg 196(4):531–534CrossRefPubMed
50.
Ammaturo C, Bassi UA, Bassi G (2010) Outcomes of the open mesh repair of large incisional hernias using an intraperitoneal composite mesh: our experience with 100 cases. Updates Surg 62(1):55–61CrossRefPubMed
51.
Bernard C, Polliand C, Mutelica L et al (2007) Repair of giant incisional abdominal wall hernias using open intraperitoneal mesh. Hernia 11(4):315–320CrossRefPubMed
52.
Martinez DA, Vazquez JL, Pellicer E et al (1999) Results of expanded polytetrafluoroethylene patches in moderate and large incisional hernias. Hernia 3(3):149–152CrossRef
53.
Moreno-Egea A, Mengual-Ballester M, Cases-Baldo MJ et al (2010) Repair of complex incisional hernias using double prosthetic repair: single-surgeon experience with 50 cases. Surgery 148(1):140–144CrossRefPubMed
54.
Liu F, Li J (2011) Repair of large abdominal wall defects using the proceed surgical mesh with open intra-peritonium onlay method. Saudi Med J 32(5):504–509PubMed
55.
Lo Monte AI, Damiano G, Palumbo VD et al (2011) Eight-point compass rose underlay technique in 72 consecutive elderly patients with large incisional hernia. Int J Gerontol 5:161–165CrossRef
56.
Shaikh FM, Giri SK, Durrani S et al (2007) Experience with porcine acellular dermal collagen implant in one-stage tension-free reconstruction of acute and chronic abdominal wall defects. World J Surg 31(10):1966–1972 discussion 73–64, 75CrossRefPubMed
57.
58.
59.
60.
61.
62.
Picazo-Yeste J, Morandeira-Rivas A, Moreno-Sanz C (2013) Multilayer myofascial-mesh repair for giant midline incisional hernias: a novel advantageous combination of old and new techniques. J Gastrointest Surg Off J Soc Surg Aliment Tract 17(9):1665–1672. doi:10.​1007/​s11605-013-2285-3 (published online first: epub date)CrossRef
63.
Carbonell Tatay F, Bonafe Diana S, Garcia Pastor P et al (2009) New surgical technique in complex incisional hernias: component separation technique (CST) with prosthesis and new muscle insertions (Nuevo metodo de operar en la eventracion compleja: separacion anatomica de componentes con protesis y nuevas inserciones musculares). Cir Esp 86(2):87–93CrossRefPubMed
64.
Chevrel JP (1979) The treatment of large midline incisional hernias by “overcoat” plasty and prothesis (author’s transl) (Traitement des grandes eventrations medianes par plastie en paletot et prothese). Nouv Presse Med 8(9):695–696PubMed
65.
Rios A, Rodriguez JM, Munitiz V et al (2001) Factors that affect recurrence after incisional herniorrhaphy with prosthetic material. Eur J Surg 167(11):855–859CrossRefPubMed
66.
Rohr S, Vogt F, Thiry CL et al (1993) Parietal prosthetic mesh in the treatment of large incisional hernias (Le pontage prothetique parietal dans le traitement des grandes eventrations). J Chir (Paris) 130(1):37–40
67.
Kingsnorth AN, Shahid MK, Valliattu AJ et al (2008) Open onlay mesh repair for major abdominal wall hernias with selective use of components separation and fibrin sealant. World J Surg 32(1):26–30. doi:10.​1007/​s00268-007-9287-9 [published Online First: Epub Date]CrossRefPubMed
68.
69.
70.
Bracci F, Pollicita S, Carnuccio P (2008) “Open” abdominal surgery for large incisional hernias: proposal of a personal technique. Chir Ital 60(3):439–443PubMed
71.
Matapurkar BG, Gupta AK, Agarwal AK (1991) A new technique of “Marlex-peritoneal sandwich” in the repair of large incisional hernias. World J Surg 15(6):768–770CrossRefPubMed
72.
Katsaragakis S, Manouras A, Stamou KM et al (2001) Modified technique for repairing large incisional hernias. Eur J Surg 167(6):458–460CrossRefPubMed
73.
Malik A, Macdonald AD, de Beaux AC et al (2014) The peritoneal flap hernioplasty for repair of large ventral and incisional hernias. Hernia J Hernias Abdom Wall Surg 18(1):39–45. doi:10.​1007/​s10029-013-1086-7 (published online first: epub date)CrossRef
74.
Ferrari GC, Miranda A, Sansonna F et al (2008) Laparoscopic management of incisional hernias > or = 15 cm in diameter. Hernia 12(6):571–576CrossRefPubMed
75.
Perrone JM, Soper NJ, Eagon JC et al (2005) Perioperative outcomes and complications of laparoscopic ventral hernia repair. Surgery 138(4):708–715 discussion 15-06CrossRefPubMed
76.
Raftopoulos I, Vanuno D, Khorsand J et al (2002) Outcome of laparoscopic ventral hernia repair in correlation with obesity, type of hernia, and hernia size. J Laparoendosc Adv Surg Tech A 12(6):425–429CrossRefPubMed
77.
78.
Ferrari G, Bertoglio C, Magistro C et al (2013) Laparoscopic repair for recurrent incisional hernias: a single institute experience of 10 years. Hernia J Hernias Abdom Wall Surg 17(5):573–580. doi:10.​1007/​s10029-013-1098-3 (published online first: epub date)CrossRef
79.
80.
Moreno-Egea A, Carrillo-Alcaraz A (2012) Management of non-midline incisional hernia by the laparoscopic approach: results of a long-term follow-up prospective study. Surg Endosc 26(4):1069–1078. doi:10.​1007/​s00464-011-2001-x (published online first: epub date)CrossRefPubMed
81.
Wormer BA, Walters AL, Bradley JF 3rd et al (2013) Does ventral hernia defect length, width, or area predict postoperative quality of life? Answers from a prospective, international study. J Surg Res 184(1):169–177. doi:10.​1016/​j.​jss.​2013.​04.​034 (published online first: epub date)CrossRefPubMed
82.
Sharma A, Mehrotra M, Khullar R et al (2011) Laparoscopic ventral/incisional hernia repair: a single centre experience of 1,242 patients over a period of 13 years. Hernia 15(2):131–139. doi:10.​1007/​s10029-010-0747-z (published online first: epub date)CrossRefPubMed
83.
84.
Bisgaard T, Kehlet H, Bay-Nielsen MB et al (2009) Nationwide study of early outcomes after incisional hernia repair. Br J Surg 96(12):1452–1457. doi:10.​1002/​bjs.​6728 (published online first: epub date)CrossRefPubMed
85.
de Vries Reilingh TS, van Geldere D, Langenhorst B et al (2004) Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia 8(1):56–59. doi:10.​1007/​s10029-003-0170-9 (published online first: epub date)CrossRefPubMed
86.
Agnew SP, Small W Jr, Wang E et al (2010) Prospective measurements of intra-abdominal volume and pulmonary function after repair of massive ventral hernias with the components separation technique. Ann Surg 251(5):981–988. doi:10.​1097/​SLA.​0b013e3181d7707b​ (published online first: epub date)CrossRefPubMed
87.
Zielinski MD, Goussous N, Schiller HJ et al (2013) Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen. Hernia 17(1):101–107. doi:10.​1007/​s10029-012-0995-1 (published online first: epub date)CrossRefPubMed
88.
Ibarra-Hurtado TR, Nuno-Guzman CM, Echeagaray-Herrera JE et al (2009) Use of botulinum toxin type a before abdominal wall hernia reconstruction. World J Surg 33(12):2553–2556. doi:10.​1007/​s00268-009-0203-3 (published online first: epub date)CrossRefPubMed
89.
Sabbagh C, Dumont F, Fuks D et al (2012) Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts: a prospective study. Hernia 16(1):33–40. doi:10.​1007/​s10029-011-0849-2 (published online first: epub date)CrossRefPubMed
90.
den Hartog D, Dur AH, Kamphuis AG et al (2009) Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias. Hernia 13(1):45–48. doi:10.​1007/​s10029-008-0420-y (published online first: epub date)CrossRef
91.
92.
93.
Muysoms F, Campanelli G, Champault GG et al (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia. doi:10.​1007/​s10029-012-0912-7 (published online first: epub date)PubMedCentralPubMed
94.
Leber GE, Garb JL, Alexander AI et al (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133(4):378–38295 CrossRefPubMed
95.
Tanaka EY, Yoo JH, Rodrigues AJ, Jr., Utiyama EM, Birolini D, Rasslan S (2010) A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia 14(1):63–69
96.
Ammaturo C, Bassi G (2005) The ratio between anterior abdominal wall surface/wall defect surface: a new parameter to classify abdominal incisional hernias. Hernia 9(4):316–321
97.
Dumanian GA, Denham W (2003) Comparison of repair techniques for major incisional hernias. Am J Surg 185(1):61–65
98.
Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, Corcione F, Fingerhut A, Flament JB, Kux M et al (2001) Classification and surgical treatment of incisional hernia. Langenbecks Arch Surg 386(1):65–73
99.
Chevrel JP, Rath AM (2000) Classification of incisional hernias of the abdominal wall. Hernia 4:7–11
Metadata
Title
A systematic review of the surgical treatment of large incisional hernia
Authors
E. B. Deerenberg
L. Timmermans
D. P. Hogerzeil
J. C. Slieker
P. H. C. Eilers
J. Jeekel
J. F. Lange
Publication date
01-02-2015
Publisher
Springer Paris
Published in
Hernia / Issue 1/2015
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-014-1321-x

Other articles of this Issue 1/2015

Hernia 1/2015 Go to the issue

Original Article

Readmission following ventral hernia repair: a model derived from the ACS-NSQIP datasets

Original Article

Randomized Clinical Trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair

Review

A detailed analysis of outcome reporting from randomised controlled trials and meta-analyses of inguinal hernia repair

Original Article

Biomechanical evaluation of fixation properties of fibrin glue for ventral incisional hernia repair

Original Article

Long-term outcomes (>5-year follow-up) with porcine acellular dermal matrix (Permacol™) in incisional hernias at risk for infection

Original Article

An international consensus algorithm for management of chronic postoperative inguinal pain