title: Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique.
abstract: BACKGROUND
  Repair of complex incisional hernias poses a major challenge.
  
  
  OBJECTIVE
  The aim of this study was to review the outcomes of the modified Rives-Stoppa repair of complex incisional hernias using a synthetic prosthesis.
  
  
  METHODS
  We reviewed patients undergoing a modified Rives-Stoppa repair of complex incisional hernias from 1990 to 2003. Patients were followed through clinic visits and mailed questionnaires. Follow-up data were complete in all patients (mean 70 months, range 24-177 months), and 87% of patients completed a mailed questionnaire. Primary outcome included mortality, morbidity, and hernia recurrence. Secondary outcome measures were duration of hospital stay, long-term abdominal wall pain, and self-reported patient satisfaction.
  
  
  RESULTS
  Altogether, 254 patients underwent a modified Rives-Stoppa repair. Among them, 60% had a significant co-morbidity, and 30% had one or more previously failed hernia repairs. Mortality was zero, and overall morbidity was 13% (wound infection 4%, prosthetic infection 3%, seroma/hematoma 4%). The overall hernia recurrence rate was 5%, including explantation of mesh because of infection. Wound/prosthetic infection was predictive for hernia recurrence (31% vs. 4%, p = 0.003). Among the respondents, 89% reported overall satisfaction with their repair.
  
  
  CONCLUSIONS
  The Rives-Stoppa repair of complex incisional hernias using synthetic prosthetic materials is safe with a low recurrence rate (5%) and high patient satisfaction. Postoperative wound infection is a risk factor for hernia recurrence.
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Corey W
authors.initials: CW
authors.lastname: Iqbal
authors.forename: Tuan H
authors.initials: TH
authors.lastname: Pham
authors.forename: Anthony
authors.initials: A
authors.lastname: Joseph
authors.forename: Jane
authors.initials: J
authors.lastname: Mai
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes / Q000627:therapeutic use; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes; D011138:Polytetrafluoroethylene