Operative therapy of secondary ventral hernia. Technical principles

Secondary ventral hernia or incisional hernia occurs in at least 20 % of cases after laparotomy and most patients are symptomatic. The pathogenesis of incisional hernia is believed to be based on a defect in collagen synthesis indicating the necessity of covering the whole original incision with a non-resorbable, macroporous mesh. These meshes can be used on top of the fascia (onlay), in a retromuscular fashion (sublay) or intraperitoneally (IPOM). The IPOM technique is the preferred procedure during laparoscopic repair of ventral hernias. The clear advantage of the laparoscopic approach is the dramatically reduced rate of wound complications, especially infections. Major defects of the abdominal wall require plastic reconstruction with the component separation technique in both anterior and posterior approaches. The component separation technique must be combined with retromuscular mesh augmentation enabling a recurrence rate of less than 10 % and an acceptable morbidity to be achieved.