title: Repair of complex giant or recurrent ventral hernias by using tension-free intraparietal prosthetic mesh (Stoppa technique): lessons learned from our initial experience (fifty patients).
abstract: BACKGROUND
  Giant complex ventral hernias are difficult to repair, and recurrent rates are high (greater than 10%). Our aim was to review our experience with a modified Stoppa technique.
  
  
  METHODS
  From 1991 to 1995, 50 patients underwent repair with a large panel of prosthetic mesh placed intraparietally posterior to rectus muscle but anterior to posterior rectus sheath; 27 had undergone one to five previous hernia repairs, and 14 patients had a simultaneous intraabdominal procedure. Mean follow-up (100%) has been 24 months.
  
  
  RESULTS
  No operative deaths occurred. Hospital morbidity included four wound infections, 2 of which were serious and required mesh removal; both occurred in patients in whom the gut was opened for other simultaneous intraabdominal procedures. Late morbidity included two delayed wound infections/limited mesh infections managed by office debridement and open packing, three seromas, and transient abdominal wall pain in seven patients. Long-term follow-up showed no recurrent hernias in the 48 patients without early serious mesh infections requiring mesh removal; thus the long-term success rate was 96% (48 of 50 patients).
  
  
  CONCLUSIONS
  Recurrent rates after this modified Stoppa repair of giant complex giant ventral hernias are very low. Early or late mesh infection occurred in four patients. Tension-free prosthetic mesh repair offers a marked improvement in outcome. Because of the possibility of mesh infection, simultaneous, contaminated, or even clean-contaminated intraperitoneal procedures should be avoided if possible.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, Minn., USA.
authors.forename: T
authors.initials: T
authors.lastname: Temudom
authors.forename: M
authors.initials: M
authors.lastname: Siadati
authors.forename: M G
authors.initials: MG
authors.lastname: Sarr
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D019736:Prostheses and Implants; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013997:Time Factors
chemical_list: D011138:Polytetrafluoroethylene