Retro-rectus repair of complex incisional hernia leads to low recurrence rate

Background: To assess the outcome of retro-rectus repair of complex abdominal wall repair (CAWR) in a single institution in relation to the use of biologic and synthetic mesh. Method: A retrospective review was undertaken of complex abdominal wall repairs performed by a single surgical team, assessing the outcome of the retro-rectus repair and factors affecting the outcome. Results: Between 2007 and 2013, 57 (33 male) patients underwent CAWR retrorectus repair. The material used was assessed as either synthetic or biologic (crosslinked porcine dermal collagen). The Ventral Hernia Working Group grades were similar between groups of patients having a repair with synthetic and biologic mesh. Median follow-up in the synthetic group was 18 months (1-80.5) and 18.4 months (0.5-70.7) in the biologic group. There was no statistical difference in seroma, wound infection or haematoma rates. No fistulae occurred in either group. Overall recurrence was 3.4% and there was no statistical difference between groups. Conclusion: The retro-rectus repair technique is associated with a low rate of recurrence and is now the technique of choice. The choice of material, biologic or synthetic, in Ventral Hernia Working Group grades 1-3 remains controversial.