Incisional hernia repair with open, retromuscular mesh augmentation

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

Excision of the skin scar
Exposure of the fascial defect
Opening of the abdominal cavity
Local adhesiolysis
Preparation of the anterior fascia
Incision of the rectus sheath
Preparation of the mesh bed
Closure of the abdominal cavity
Measuring the mesh bed
Mesh placement and fixation
Fascial closure of the anterior rectus sheath
Refixation of the navel and layered wound closure

Authors

Prof. Dr. med. Volker Schumpelick

Universitätsklinikum Aachen

PD Dr. med. Joachim Conze

Hernienzentrum München

Date

date of publication: 25.04.2009
date of update: 10.04.2024

Excision of the skin scar

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The existing skin scar is completely excised.
Exposure of the fascial defect

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Preparation down to the fascia and exposure of the entire fascial scar.
Opening of the abdominal cavity

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The abdominal cavity is opened in the area of the hernia sac, with the fascial scar being completely transected. It is not sufficient to only repair the fascial defect, as there are often additional defects along the course of the fascial scar in the form of a mesh hernia.
Local adhesiolysis

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The local adhesiolysis of visceral organs from the hernia sac and the adjacent abdominal wall allows for better visualization, preventing iatrogenic bowel lesions during further preparation of the omental bed. Subsequently, the abdominal cavity is protectively covered with a warm, moist cloth.
Note: An inter-enteric adhesiolysis should only be performed if there are corresponding symptomatic complaints.
Preparation of the anterior fascia

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A careful epifascial preparation of the anterior fascia is performed, including the hernia sac. This facilitates the subsequent preparation of the mesh bed and the later closure of the fascia.