Open Mesh Repair of Incisional Hernia Using a Sublay Technique: Long-Term Follow-up

Background Reported results of incisional hernia repair are poor with high recurrence rates unless prosthetic mesh is used. Mesh gives improved results, but certain techniques are associated with a high incidence of infections, fistulas, and seromas. This study reports the results of a consecutive series of incisional hernias repaired using an open sublay technique with retromuscular mesh placement. The primary endpoint was hernia recurrence. Secondary endpoints were complications and long-term discomfort. Methods A total of 125 patients were operated on between 1991 and 2001. In 2002 they were sent a questionnaire and asked to return for examination if they thought their hernia had recurred or if they had pain. A second questionnaire was sent in 2005, and all patients were asked to return for examination. Results There were no postoperative deaths and no major systemic complications. There were no early (within 30 days) wound infections; the mesh subsequently became infected in two patients and had to be removed. Seromas developed in 12 patients. In 2002, a total of 106 questionnaires were returned; 3 patients had died of unrelated causes, and 16 were untraceable despite repeated attempts. There were five (4%) recurrences. Altogether, 6 patients had abdominal wall discomfort, and 49 patients spontaneously wrote that they were pleased or very pleased with the long-term result. At a second follow-up a mean of 8 years after operation (95 months; range 46–168 months) patients were assessed by an independent observer, and there were no further recurrences. Conclusions Open repair of incisional hernias with mesh in the subfascial plane is highly effective with acceptable complication rates. Surgeon experience and a team approach are important factors in obtaining good results. Trials comparing open with laparoscopic repair are needed. The development of an incisional hernia is a significant complication of laparotomy, with an (estimated) incidence between 10% and 15% [1–4]. Apart from the risk of bowel strangulation, it has an impact on patients’ quality of life. The reported results of incisional hernia repair vary widely, with high recurrence rates for sutured repair alone [1, 5–8]. Using prosthetic mesh gives improved results [5, 6, 9, 10], but the positioning and type of mesh used are critical factors, and certain techniques are associated with a high incidence of complications (infection, fistula, seroma) [11–13]. Current debate focuses on whether the mesh repair should be laparoscopic or open [14, 15] and, if open, in which abdominal wall plane the mesh should be placed. This study reports the results of a prospective series of consecutive incisional hernias repaired using an open technique and retromuscular mesh placement (sublay technique). The primary endpoint was hernia recurrence. Secondary endpoints were complications and long-term discomfort.