title: Giant midline abdominal incisional herniae repair through combined retro-rectus mesh placement and components separation: experience from a single centre.
abstract: OBJECTIVE
  Giant midline abdominal wall incisional herniae require repair/reconstruction to restore the structural and functional continuity of the anterior abdominal wall. We describe here our approach to these demanding cases through a combined retro-rectus mesh placement and components separation and their overall functional outcome.
  
  
  METHODS
  A retrospective analysis of a prospectively collected data was carried out and 28 patients who underwent giant (≥15 cm) midline incisional hernia reconstruction were identified in a large district general hospital between 2007 and 2013 with a median follow-up of 34 (6-76) months.
  
  
  RESULTS
  Demographic data of our series include age of 60 (median) (30-87) years with a M:F ratio of 12:16, length of symptomatic hernia 18 (median) (12-36) months, more than two previous laparotomies (15), bowel obstructive symptoms (7) and recurrent herniation (7). BMI recorded was 32 (median) (24-46) and ASA of II (median) (I-III). Co-morbidities included cardiac disease (6), diabetes (6), respiratory disease (4) and systemic immunocompromise (2). Operative and technical details showed operative duration to be 180 (median) min, cranio-caudal rectus sheath defect 21 (median) cm, transverse rectus sheath defect 15 (median) cm, cross-sectional area of fascial defect 300 (median) cm(2) and size of mesh 690 (median) cm(2). Seven (25 %) developed short-term post operative complications: grade I seromata all resolving spontaneously (5); grade II superficial wound infections (2). Twenty-five (89 %) were completely asymptomatic at 34 (median) months' follow-up; 2 (7 %) reported mild pain, but not limiting any activity; 1 (4 %) described pain occasionally limiting activity. There was no clinical recurrence with one patient developing global bulging.
  
  
  CONCLUSIONS
  Our series is comparable to the literature in patient cohort demographics, co-morbidity and risk factor profile; however, we demonstrate an excellent intermediate term outcome with no clinical recurrence and an improvement in quality of life, through their ability to perform normal day to day activities.
authors.affiliation: Department of General Surgery, General Surgical Directorate, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Kennington Road, Willesborough, Ashford, Kent, TN24 0LZ, UK.
authors.forename: R
authors.initials: R
authors.lastname: Kumar
authors.forename: A K
authors.initials: AK
authors.lastname: Shrestha
authors.forename: S
authors.initials: S
authors.lastname: Basu
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D017568:Rectus Abdominis / Q000601:surgery; D012189:Retrospective Studies; D013526:Surgical Mesh