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Evidence - Open incisional hernia repair with retromuscular mesh augmentation

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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Literature summary

    Literature summary

    Incisional hernia is a disorder of the connective tissue with impaired collagen synthesis. This explains the need for augmenting the entire fascial scar (10,15-17).

    Incisional hernias should no longer be repaired by conventional suture techniques since these are burdened by a rather high rate of recurrence. Depending on the duration of the follow-up, the rate of recurrence is > 60% (1,7,23,29). ↑↑

    In open repair of midline incisional hernias, retromuscular mesh augmentation has become the technique of choice. Analysis of retrospective patient populations has yielded rates between 2% and 7.3% (see table). To date, there has only been one prospective randomized clinical trial on retromuscular mesh augmentation (3). ↑↑

  2. Ongoing trials on this topic

    For other ongoing trials see: www.controlled-trials.com

  3. References on this topic

    1. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578-583

    2. Conze J, Junge K, Klinge U, Schumpelick V (2006) Evidenzbasierte laparoskopische Chirurgie – Narbenhernie. Viszeralchirurgie 41:246-252

    3. Conze J, Kingsnorth AN, Flament JB, Simmermacher R, Arlt G, Langer C, Schippers E, Hartley M, Schumpelick V (2005) Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair. Br.J Surg 92:1488-1493

    4. Conze J, Klinge U, Schumpelick V (2005) [Incisional hernia] Chirurg 76:897-909

    5. Conze J, Prescher A, Kisielinski K, Klinge U, Schumpelick V (2004) Technical consideration for subxiphoidal incisional hernia repair. Hernia

    6. Conze J, Prescher A, Klinge U, Saklak M, Schumpelick V (2004) Pitfalls in retromuscular mesh repair for incisional hernia: the importance of the “fatty triangle”. Hernia 8:255-259

    7. den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev: CD006438

    8. Israelsson LA, Smedberg S, Montgomery A, Nordin P, Spangen L (2006) Incisional hernia repair in Sweden 2002. Hernia 10:258-261

    9. Junge K, Klinge U, Prescher A, Giboni P, Niewiera M, Schumpelick V (2001) Elasticity of the anterior abdominal wall and impact for reparation of incisional hernias using mesh implants. Hernia 5:113-118

    10. Junge K, Klinge U, Rosch R, Mertens PR, Kirch J, Klosterhalfen B, Lynen P, Schumpelick V (2004) Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbecks Arch Surg 389:17-22

    11. Kapischke M, Schulz T, Schipper T, Tensfeldt J, Caliebe A (2008) Open versus laparoscopic incisional hernia repair: something different from a meta-analysis. Surg Endosc. 22:2251-2260

    12. Klinge U, Conze J, Klosterhalfen B, Limberg W, Obolenski B, Ottinger AP, Schumpelick V (1996) [Changes in abdominal wall mechanics after mesh implantation. Experimental changes in mesh stability]. Langenbecks Arch Chir 381:323-332

    13. Klinge U, Conze J, Krones CJ, Schumpelick V (2005) Incisional Hernia: Open Techniques. World J Surg. 2005 Aug;29(8):1066-72.

    14. Klinge U, Klosterhalfen B, Conze J, Limberg W, Obolenski B, Ottinger AP, Schumpelick V (1998) Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall. Eur.J Surg 164:951-960

    15. Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B (2000) Abnormal collagen I to III distribution in the skin of patients with incisional hernia. Eur.Surg Res. 32:43-48

    16. Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B (2001) Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg 14:47-54

    17. Klinge U, Zheng H, Si ZY, Schumpelick V, Bhardwaj R, Klosterhalfen B (1999) Synthesis of type I and III collagen, expression of fibronectin and matrix metalloproteinases-1 and -13 in hernial sac of patients with inguinal hernia. Int.J Surg Investig. 1:219-227

    18. Kurzer M, Kark A, Selouk S, Belsham P (2008) Open mesh repair of incisional hernia using a sublay technique: long-term follow-up World J Surg 32:31-36

    19. Ladurner R, Trupka A, Schmidbauer S, Hallfeldt K (2001) [The use of an underlay polypropylene mesh in complicated incisional hernias: sucessful French surgical technique]. Minerva Chir 56:111-117

    20. Langer C, Liersch T, Kley C, Flosman M, Suss M, Siemer A, Becker H (2003) [Twenty-five years of experience in incisional hernia surgery. A comparative retrospective study of 432 incisional hernia repairs]. Chirurg 74:638-645

    21. Langer C, Neufang T, Kley C, Schonig KH, Becker H (2001) [Standardized sublay technique in polypropylene mesh repair of incisional hernia. A prospective clinical study]. Chirurg 72:953-957

    22. Le H, Bender JS. Le Retrofascial mesh repair of ventral incisional hernias. Am J Surg. 2005 Mar;189(3):373-5. 

    23. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl.J Med 343:392-398

    24. McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SR, Laycock WS, Birkmeyer JD (2003) A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc. 17:1778-1780

    25. McLanahan D, King LT, Weems C, Novotney M, Gibson K (1997) Retrorectus prosthetic mesh repair of midline abdominal hernia. Am. J Surg 173:445-449

    26. Paajanen H, Hermunen H. Long-term pain and recurrence after repair of ventral incisional hernias by open mesh: clinical and MRI study. Langenbecks Arch Surg. 2004 Oct;389(5):366-70. 

    27. Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827-831

    28. Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig MK (2008) Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg.

    29. Schumpelick V, Conze J, Klinge U (1996) [Preperitoneal mesh-plasty in incisional hernia repair. A comparative retrospective study of 272 incisional hernia repairs]. Chirurg 67:1028-1035

    30. van’t RM, Vrijland WW, Lange JF, Hop WC, Jeekel J, Bonjer HJ (2002) Mesh repair of incisional hernia: comparison of laparoscopic and open repair. Eur.J Surg 168:684-689

    31. Wright BE, Niskanen BD, Peterson DJ, Ney AL, Odland MD, VanCamp J, Zera RT, Rodriguez JL (2002) Laparoscopic ventral hernia repair: are there comparative advantages over traditional methods of repair? Am.Surg 68:291-295

  4. literature search

    Literature search on the pages of pubmed.