Modified onlay technique for the repair of the more complicated incisional hernias: single-centre evaluation of a large cohort

The repair of incisional hernias remains a challenge for the general surgeon. Indications for surgery are severe bowel obstruction, as well as aesthetic problems. There are various surgical methods to correct these hernias, with varying results. However, the gold standard has not yet been found. Both laparoscopic repair and the component separation technique (CTS) have proven to be acceptable techniques; however, they are not always suitable for resolving the more complicated abdominal wall defects, i.e. after open-abdomen treatment or fascial necrosis. In our hospital, we developed a new onlay technique which we have evaluated in the following research. During a period of 10 years (1996-2007), 101 patients with an incisional hernia were corrected with the new onlay technique. A Marlex mesh of dimensions at least 10 x 20 cm was used, overlapping the fascia by at least 5 cm on each side. This mesh was stapled onto the fascia with skin staples. Of the 101 patients, there were 45 men and 56 women, with a mean age of 55 years. Nine patients died and 13 were lost during follow-up. Of the remaining 79 patients, eight refused to participate. The mean follow-up time was 64 months (normal distribution, standard deviation [SD] 34 months). This cohort of 101 patients was studied retrospectively. Seventy-one of the 101 patients were evaluated at our out-patient clinic. For 24 patients (25%), the operation was for a recurrence after an incisional hernia correction in the past. Twenty-one patients (20%) had an open-abdomen treatment in their medical history. The surgical procedure was technically possible in all patients and the mean operation time was 63 min. The median admission time was 4.5 days (quartiles 3-6.25). The mean follow-up time was 64 months (SD 35 months). A seroma was reported in 27 of 101 patients (27%) and a wound infection in 22 patients (21%), of which seven patients had to be re-operated. Only if a patient was evaluated at our out-patient clinic could reherniation have been scored; this occurred in 11 of 71 patients (16%). This technique is an effective and simple procedure to correct incisional hernias with acceptable complication rates and is feasible even in the more complicated hernias.