Long-Term Follow-Up of Retromuscular Incisional Hernia Repairs: Recurrence and Quality of Life: Reply

Excerpt

Thank you for your interest in our work [1]. Our belief is that the success of a retromuscular mesh repair of an incisional hernia is dependent on a sufficient overlap of the mesh that could almost always be achieved. This space is ‘the golden pocket’ of the abdominal wall. The intestines are not exposed to the mesh in this space, as they are in the intraperitoneal onlay mesh (IPOM) position being a potential cause for intraabdominal adhesions. The mesh in the retromuscular space allows for collagen ingrowth and a fast process into the maturation phase as the mesh is in close contact with the well vascularised tissue of the rectal muscle, further supported by the intraabdominal pressure. In our study the retromuscular space was achieved by opening the rectus abdominis sheaths on the ventral side, according to the Rives-Stoppa procedure [2]. The posterior borders of the rectus sheaths were extended by the small flaps from the anterior facial incision making it possible to close the posterior wall to create a flat surface for the mesh. This increases the distance between the anterior rectus sheaths. By suturing the border of the anterior sheath to the mesh we avoided high tension on the midline in patients with a large defect in the aponeurosis. …