Incisional hernias represent a frequently treated pathology by all surgeons. We all treat incisional hernias that arise in patients who were operated by us or by other fellow surgeons. Meaning that only the surgeon who does not operate does not have such a complication.
There are three options for hernia repair: herniorrhaphy, hernioplasty, combination of both. Some works have demonstrated that the use of a mesh can decrease recurrence. However, must not forget that a mesh is a foreign body with potential post-operative complications. Even though, the use of prosthesis is advised in the majority of cases. “Onlay”, “Inlay”, “Sublay” are all valid options for prosthesis placement. In my opinion, “Sublay” represents the best option with reports showing the lowest recurrence rates.
There are two techniques available for ventral incisional hernia repair, accepted as the best options with the lowest recurrence rates. Both techniques use a ”Sublay” prosthesis but differ in the exact location where the mesh fits in:
Rives-Stoppa-Wanz technique: mesh is placed between rectus muscle and its posterior fascia (prosthesis does not contact with bowel)
Intraperitoneal Rives-like technique: prosthesis is intraperitoneal and in contact with bowel (double layer prosthesis)
We have all learned that adhesions would be a contraindication for laparoscopy. Well… Nowadays this is not an absolute truth. In fact, laparoscopy can be of good help for break down adhesions and create a free space for a safe hernia repair. In this setting, I present you a new video showing a repair of two incisional hernias following a midline laparotomy in a male patient. An intraperitoneal laparoscopic repair was conducted using a double layer prosthesis to cover both defects.
Please, use the link bellow to assist the video. Enjoy and comment as you wish.
Link to Surgical Videos:
Link to YouSurg – Surgery on Video (YouTube):
Dr. Carlos Eduardo Costa Almeida
General Surgeon