title: A novel technique for modified onlay incisional hernia repair with mesh incorporation into the fascial defect: a method for addressing suture line failure.
abstract: OBJECTIVE
  Biological mechanisms such as abnormal wound healing and impaired scar formation are important aetiological factors in the development of abdominal wall hernias. Standard onlay repair often involves suture closure of the fascial defect with placement of the mesh over this closed defect. This has the disadvantage that suture line failure may occur early in the healing process and predispose to recurrence. Our technique aims to overcome this by incorporating the mesh into the fascial closure. The aim of this retrospective study was to audit recurrence rate and surgical complications relating to this modified repair.
  
  
  METHODS
  This study included all patients undergoing incisional hernia repair over a 5-year period under a single consultant. An initial stitch was taken through the Ultrapro(TM) mesh and fascia on one side of the defect followed by the fascia and mesh on the other side. By repeating this process with a continuous suture, the mesh was incorporated into the fascial defect closure. Telephone survey was performed, and where there was suspicion of a recurrence patients were brought back to the outpatient clinic.
  
  
  RESULTS
  The study included 72 patients with a median follow-up of 29 months. There was a 7 % recurrence rate and a 10 % minor complication rate, with no patient requiring readmission or mesh removal. In 70 % of patients the procedure was performed as a day case and 90 % were satisfied with the repair.
  
  
  CONCLUSIONS
  This is a promising new technique that aims to address suture line failure and the significant recurrence rate that occurs with incisional hernia repair.
authors.affiliation: Epsom and St Heliers NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK, kjamal@doctors.org.uk.
authors.forename: K
authors.initials: K
authors.lastname: Jamal
authors.forename: K
authors.initials: K
authors.lastname: Ratnasingham
authors.forename: S
authors.initials: S
authors.lastname: Shaunak
authors.forename: K
authors.initials: K
authors.lastname: Ravindran
authors.forename: D
authors.initials: D
authors.lastname: Nehra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000071938:Fasciotomy; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh; D013536:Suture Techniques / Q000009:adverse effects; D013537:Sutures / Q000009:adverse effects; D016896:Treatment Outcome; D014945:Wound Healing