Retromsacular preperitoneal versus traditional onlay mesh repair in treatment of incisional hernias

ABSTRACT

Incisional hernia is a common surgical condition with a reported incidence of 2-11% following all laparotomies. Repair of large abdominal incisional hernia is a difficult surgical problem with recurrence being a common outcome that may reach up to 33%. The introduction of polypropylene mesh repair opened a new era of tension-free herniorrhaphy. However, implantation of the mesh by open techniques requires wide dissection of soft tissue contributing to an increase in wound infection and wound-related complications. The objective of this study was to compare preperitoneal versus onlay mesh repair in treatment of incisional hernia. This study included 67patients with incisional hernia from January 2004 to January 2007. The patients were randomly divided into two groups; Group I, [32 patients] for whom onlay mesh repair was done and Group II, [35 patients] for whom preperitoneal mesh repair was done. Both repairs were evaluated in regards to operative time, intraoperative difficulties and postoperative complications. Results were documented and statistically analyzed. 67 patients with incisional hernia were included in this study. Group I included 32 patients for whom traditional onlay mesh was preformed while group II included 35 patients for whom retromuscular preperitoneal mesh repair was performed. There was no statistically significant difference between both groups as regards age and sex [P > 0.05]. The mean operative time in Group I was 70 +/- 8.6 min, while it was 74 +/- 9.8 min in Group II with no statistically significant difference between both groups [P > 0.05]. The mean of the period of drainage was 7 +/- 1.3 days, while it was 2 +/- 0.8 days in Group II which was statistically longer than group I [P < 0.05]. Seroma occurred in 4 patients in Group I, while it was not encountered in any patient in Group II [P < 0.05]. No recurrence was reported throughout the period of follow up which ranged from 6-36 months in both groups. Based on this analyses, we believe that preperitoneal mesh repair is the ideal operation for incisional hernias. There are however, very few publications covering this technique of repair