Published in:
01-10-2014 | Original Article
Giant midline abdominal incisional herniae repair through combined retro-rectus mesh placement and components separation: experience from a single centre
Published in: Hernia | Issue 5/2014
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Aims
Giant midline abdominal wall incisional herniae require repair/reconstruction to restore the structural and functional continuity of the anterior abdominal wall. We describe here our approach to these demanding cases through a combined retro-rectus mesh placement and components separation and their overall functional outcome.
Methods
A retrospective analysis of a prospectively collected data was carried out and 28 patients who underwent giant (≥15 cm) midline incisional hernia reconstruction were identified in a large district general hospital between 2007 and 2013 with a median follow-up of 34 (6–76) months.
Results
Demographic data of our series include age of 60 (median) (30–87) years with a M:F ratio of 12:16, length of symptomatic hernia 18 (median) (12–36) months, more than two previous laparotomies (15), bowel obstructive symptoms (7) and recurrent herniation (7). BMI recorded was 32 (median) (24–46) and ASA of II (median) (I–III). Co-morbidities included cardiac disease (6), diabetes (6), respiratory disease (4) and systemic immunocompromise (2). Operative and technical details showed operative duration to be 180 (median) min, cranio-caudal rectus sheath defect 21 (median) cm, transverse rectus sheath defect 15 (median) cm, cross-sectional area of fascial defect 300 (median) cm2 and size of mesh 690 (median) cm2.
Seven (25 %) developed short-term post operative complications: grade I seromata all resolving spontaneously (5); grade II superficial wound infections (2). Twenty-five (89 %) were completely asymptomatic at 34 (median) months’ follow-up; 2 (7 %) reported mild pain, but not limiting any activity; 1 (4 %) described pain occasionally limiting activity. There was no clinical recurrence with one patient developing global bulging.
Conclusions
Our series is comparable to the literature in patient cohort demographics, co-morbidity and risk factor profile; however, we demonstrate an excellent intermediate term outcome with no clinical recurrence and an improvement in quality of life, through their ability to perform normal day to day activities.