Vertical Mayo repair of midline incisional hernia:: Suggested guidelines for selection of patients

Objective: To find out whether the vertical Mayo repair should be done for midline incisional hernias. Design: Retrospective study. Setting: University hospital, Austria. Subjects: 208 patients who presented with a primary midline incisional hernia during the period January 1991 to December 1996. Interventions: Incisional hernia repair using the vertical Mayo technique. Main outcome measures: Recurrence rates, risk factors, common practice. Results: There were 60 recurrences (29%) and median follow up was 6 years (range 4-8). Four risk factors (cirrhosis, chronic cough, obesity (BMI (>)30), and hernia width (>)4 cm) were identified, which were independently predictive of hernia recurrence. All 60 patients with a recurrent hernia had at least two of the four risk factors. The remaining 148 patients who did not develop a recurrence had no risk factors, or only one. Recurrence could therefore be predicted with a sensitivity of 80% and a specificity of 96%. Conclusion: The vertical Mayo repair is a good method for the repair of incisional hernias if not more than one of the four significant risk factors is present. The presence of two or more risk factors is predictive of a high rate of recurrence, and other techniques, such as alloplastic mesh repair, should be considered.