- Intraoperative Bleeding
Especially of the epigastric vessels or their branches at the lateral edge of the rectus sheath
Therapy: immediate suturing/hemostasis
- Bowel Injury during Adhesiolysis
Prophylaxis: careful, layer-by-layer dissection, if necessary, start dissection in an area free of defects, from there display the fascial defect and the hernia contents. Early opening of the hernia sac.
Deserosations must be recognized and immediately oversewn.
In the case of transmural lesions, the location (small intestine-large intestine) and the amount of bowel content leakage are crucial, possibly postponing the mesh implantation.
- Inability to Close the Anterior Rectus Sheath
Bridging Technique: In cases where the anterior fascial layers cannot be completely united, fixation of the fascial edges on the mesh already placed in the sublay position with a continuous non-absorbable suture in the sense of partial anterior bridging is permissible. If a large hernia is treated with a dorsal fascial closure, a sublay mesh in a retromuscular position, and minimal residual bridging of the anterior fascia, and a primary skin closure is achieved over it, a satisfactory result can be expected.