title: [Subxiphoid incisional hernia treatment: a technique using a double mesh adjusted to the defect].
abstract: BACKGROUND
  Subxiphoid incisional hernia has characteristics that differentiate it from the rest and make it a distinctive entity. The fact that it has its sac very near the rib cage and sternum determines the pressure in the margins. The repair, by open or by laparoscopic approach, has not demonstrated good results despite the generalised use of a prosthesis. They are uncommon, and have a significant comorbidity in patients (severe heart diseases, transplants, immunosuppressed), after surgery of the hepato-bilio-pancreatic area with transverse incisions, or very high mid-laparotomies for gastro-oesophageal surgery.
  
  
  METHODS
  A new technique has been developed in our Unit, based on a double mesh and adapted to the anatomical and physiological characteristics of the region. The series consisted of 35 consecutive patients operated on between 2004 and 2010, following an agreed surgical and management protocol.
  
  
  RESULTS
  There were no significant complications -the most frequent (17.4%) was a seroma- except one case of a wound infection due to skin ischaemia in one patient who had had multiple operations and a transplant. During the post-surgical follow up to the present (between 4 and 80 months), there has been no recurrence of the incisional hernia and no significant local discomfort has been reported.
  
  
  CONCLUSIONS
  The «adjusted double mesh» technique achieved good results in our hands, from the surgical point of view (reproducibility, recurrence), and for the patient, with minimal discomfort and recovery of quality of life.
authors.affiliation: Unidad de Cirugía de Pared Abdominal, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Fe, Valencia, España. fernandocarbonelltatay@gmail.com
authors.forename: Fernando
authors.initials: F
authors.lastname: Carbonell Tatay
authors.forename: Providencia
authors.initials: P
authors.lastname: García Pastor
authors.forename: José
authors.initials: J
authors.lastname: Bueno Lledó
authors.forename: María
authors.initials: M
authors.lastname: Saurí Ortiz
authors.forename: Santiago
authors.initials: S
authors.lastname: Bonafé Diana
authors.forename: José
authors.initials: J
authors.lastname: Iserte Hernández
authors.forename: Fernando
authors.initials: F
authors.lastname: Sastre Olamendi
mesh_terms: D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D013249:Sternum; D013526:Surgical Mesh; D013514:Surgical Procedures, Operative / Q000379:methods