Modified retrorectus procedure for repair of midline incisional hernias

ABSTRACT

Background: Incisional hernias develop after abdominal operations. Primary closure procedures carry high recurrence rates. Prosthetic repairs with different modifications have reduced the recurrence rates and are the procedures of choice for incisional hernia repair.Methods: Our study is a prospective study conducted on 30 patients of midline incisional hernia. Hernia repair was done by modified retrorectus technique with in which the mesh is placed between the rectus abdominis muscle and the posterior rectus sheath.Results: In our study, the hernia defect ranged from 25-40 cm2.The mesh size used ranged from 15×15 to 30×20 cm. Mean duration of hospital stay was 9.9±2.3 days. Operative time ranged from 90-150 minutes. Follow up period ranged from 3-15 months. There were no post-operative complications in 73.3% cases. Seroma formation occurred in 10% cases and wound infection was seen in 10% cases. One patient developed mesh infection which required partial removal of mesh. There was no recurrence, no mortality, no bowel injury or adhesion obstruction. Wound related complications and morbidity was higher in patients with risk factors and comorbidities like diabetes, obesity, anaemia, COPD, hypoalbuminemia and patients on steroids.Conclusions: The retrorectus technique for the repair of midline incisional hernia using polypropylene mesh is a safe and durable procedure with excellent long-term results, minimal comorbidities and least recurrence rates and is an open procedure of choice for the repair of large incisional hernias.