title: Low recurrence rate of a two-layered closure repair for primary and recurrent midline incisional hernia without mesh.
abstract: BACKGROUND
  Incisional hernia is a serious complication after abdominal surgery and occurs in 11-23% of laparotomies. Repair can be done, for instance, with a direct suture technique, but recurrence rates are high. Recent literature advises the use of mesh repair. In contrast to this development, we studied the use of a direct suture repair in a separate layer technique. The objective of this retrospective observational study is to assess the outcomes (recurrences and complications) of a two-layered open closure repair for primary and recurrent midline incisional hernia without the use of mesh.
  
  
  METHODS
  In an observational retrospective cohort study, we analysed the hospital and outpatient records of 77 consecutive patients who underwent surgery for a primary or recurrent incisional hernia between 1st May 2002 and 8th November 2006. The repair consisted of separate continuous suturing of the anterior and posterior fascia, including the rectus muscle, after extensive intra-abdominal adhesiolysis.
  
  
  RESULTS
  Forty-one men (53.2%) and 36 women (46.8%) underwent surgery. Sixty-three operations (81.8%) were primary repairs and 14 (18.2%) were repairs for a recurrent incisional hernia. Of the 66 patients, on physical examination, three had a recurrence (4.5%) after an average follow-up of 2.6 years. The 30-day postoperative mortality was 1.1%. Wound infection was seen in five patients (6.5%).
  
  
  CONCLUSIONS
  A two-layered suture repair for primary and recurrent incisional hernia repair without mesh with extensive adhesiolysis was associated with a recurrence rate comparable to mesh repair and had an acceptable complication rate.
authors.affiliation: Department of Surgery, Red Cross Hospital, Vondellaan 13, Beverwijk 1942 LE, The Netherlands.
authors.forename: A H M
authors.initials: AH
authors.lastname: Dur
authors.forename: D
authors.initials: D
authors.lastname: den Hartog
authors.forename: W E
authors.initials: WE
authors.lastname: Tuinebreijer
authors.forename: R W
authors.initials: RW
authors.lastname: Kreis
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011336:Probability; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology; D013536:Suture Techniques; D013718:Tensile Strength; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology