Dynamic patchplasty--a tension-free reconstruction of incisional hernias.
OBJECTIVE
An anatomical and physiological reconstruction of the abdominal wall after incisional hernia must include reconstruction of the linea alba to restore the physiological function of the vertebral column and respiration. Against this background, a special reconstruction method employing a mesh, which is performed in our department, is presented.


METHODS
In the period between 1 January 2000 and 1 June 2004, a total of 106 patients with incisional hernias after median laparotomy of the upper and lower abdomen were operated on in our department using this tension-free technique with one or two meshes. We have now evaluated the outcomes after a median follow-up of 25.8 months (6.5-53.3).


RESULTS
In one patient (0.9%), the peritoneal sac was inadvertently opened, resulting in injury to the small bowel serosa. Surgical complications were observed in 14 patients (13.2%) after dynamic patchplasty. In seven cases (6.6%), wound healing disorders were seen. Overall, 6 out of 106 (5.5%) patients needed revision surgery. In the follow-up period, 92 patients (follow-up 86.8%) could be contacted and re-examined. Four patients (3.8%) had died. There were four recurrences (4.3%), which had already been repaired, and one chronic seroma, which caused no symptoms and which was detected in ultrasound and computed tomography.


CONCLUSIONS
In view of the possibility of achieving physiological reconstruction and in the light of a tolerable morbidity rate, dynamic patchplasty is a suitable method for incisional hernias. Long-term results hold out promise of an acceptable low recurrence rate.
Schug-Pass
Christine
C
Centre for Minimally Invasive Surgery, Department of Surgery, Hanover Hospital, Roesebeckstrasse 15 (Siloah), 30449, Hanover, Germany. christine.schug-pass.siloah@klinikum-hannover.de
Trommer
Yvonne
Y
Tamme
Carsten
C
Lippert
Hans
H
Köckerling
Ferdinand
F
D000005:Abdomen / Q000601:surgery*; D034861:Abdominal Wall / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D019736:Prostheses and Implants; D012008:Recurrence; D012086:Reoperation; D013526:Surgical Mesh; D013536:Suture Techniques; D014945:Wound Healing / Q000502:physiology