title: The peritoneal flap hernioplasty for repair of large ventral and incisional hernias.
abstract: BACKGROUND
  Mesh repair of large ventral or incisional hernias is problematic when primary fascial closure cannot be achieved, as this leaves mesh exposed, bridging the gap. We describe a modified retromuscular sublay repair which overcomes this problem and report a retrospective review of cases to assess outcome.
  
  
  METHODS
  Mesh is positioned between transposed flaps of preserved hernial sac and rectus sheath. Patients undergoing this repair by one author (BT) from 1 January 2004 to 31 December 2010 were identified, and clinical outcome was assessed by a combination of case-note review, outpatient consultation and telephone interview.
  
  
  RESULTS
  Twenty-one ventral and incisional hernias were treated by this method. Eighteen were incisional (13 midline, three transverse and two oblique incisions), and three were primary paraumbilical hernias. Defect sizes ranged from 25 to 500 cm(2) and mesh sizes from 300 to 900 cm(2). Patients were reviewed at 6 weeks, 6 months and at a median of 37 months post-operatively. Three cases of superficial skin edge necrosis, two superficial wound infections and two sizeable seromas developed, but all had resolved within 6 months. One patient developed abdominal wall necrosis requiring mesh removal and eventual abdominal wall reconstruction without mesh, resulting in late recurrence. All other cases achieved excellent long-term outcomes with a high degree of patient satisfaction.
  
  
  CONCLUSIONS
  This is a useful method for repairing large ventral and incisional hernias when primary fascial closure is not achievable, combining a sublay mesh repair with autologous tissue transposition across the fascial gap.
authors.affiliation: Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
authors.forename: A
authors.initials: A
authors.lastname: Malik
authors.forename: A D H
authors.initials: AD
authors.lastname: Macdonald
authors.forename: A C
authors.initials: AC
authors.lastname: de Beaux
authors.forename: B R
authors.initials: BR
authors.lastname: Tulloh
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000071938:Fasciotomy; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D017060:Patient Satisfaction; D010537:Peritoneum / Q000601:surgery*; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D013524:Surgical Flaps; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000209:etiology