A hybrid technique for recurrent incisional hernia repair.
OBJECTIVE
The aim of this technical report is to investigate the safety and effectiveness of a hybrid technique for recurrent incisional hernia repair, which combines the conventional and laparoscopic approaches.


METHODS
Six patients suffering from recurrent and complicated incisional hernias underwent a hybrid technique for their repair. The open part of the operation ensured extensive and safe adhesiolysis, reduction of the hernia content into the peritoneal cavity, and proper placement of the bowel loops into the peritoneal cavity, minimizing the risk of bowel perforation. For the laparoscopic part of the procedure, intraperitoneal (underlay) e-PTFE mesh placement, of the appropriate size covering the actual hernia size and the scar edges for at least 3 cm, was laparoscopically fixated by transfascial stay stitches, allowing stretch of the mesh on the anterior abdominal wall, probably avoiding the mesh deformation in the future.


RESULTS
The overall size of the fascial defect was calculated between 116 and 187 cm, the size of the mesh used ranged from 308 to 468 cm, the total operative time ranged from 128 to 207 minutes and within a maximum follow-up period of 12 months, all patients are asymptomatic without any evidence of hernia recurrence.


CONCLUSIONS
The hybrid technique is safe in cases of recurrent or complicated or difficult incisional hernias. A longer follow-up period is required to estimating the effectiveness and the cost-effectiveness of the method.
Griniatsos
John
J
First Department of Surgery, University of Athens, Medical School, LAIKO Hospital, Athens, Greece. johngriniatsos@yahoo.com
Yiannakopoulou
Eugenia
E
Eugenia
Yiannakopoulou
Y
Tsechpenakis
Anastasios
A
Anastasios
Tsechpenakis
T
Tsigris
Christos
C
Christos
Tsigris
T
Diamantis
Theodoros
T
Theodoros
Diamantis
D
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006555:Hernia, Ventral / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D012449:Safety; D055502:Secondary Prevention; D013526:Surgical Mesh; D013536:Suture Techniques