title: Lower recurrence rate with full-thickness mesh fixation in incisional hernia repair.
abstract: OBJECTIVE
  To share the lower recurrence rate achieved during long-term follow-up by repairing incisional hernias (IHs) with full-thickness fixation of onlay mesh.
  
  
  METHODS
  We retrospectively analyzed 196 IH cases operated on by the same surgeon between 2002 and 2013. After exclusions (unrelated death, lack of follow-up), 154 cases were included. Abdominal examination findings, recurrence dates (if accessible), and imaging results were obtained from computer records and evaluated. Intraoperatively, all hernial sac adhesions were separated to reveal the anterior abdominal wall, and full-thickness suspension sutures were placed 6-8 cm lateral to the fascial edge at 2-cm intervals, excluding the peritoneum. The primary fasciae were closed, suspension sutures were passed through the mesh holes, and the mesh was fixed as an onlay, leaving no space between the fasciae.
  
  
  RESULTS
  In total, 154 subjects with IHs were analyzed: 107 (69.5%) females and 47 (30.5%) males. The mean patient age was 52.60 years [standard deviation (SD) 11.24 years], and the mean fascial defect diameter was 77 cm(2). The average operation time was 128 min (SD 42.5 min), and the average patient follow-up time was 54 months (SD 22.8 months). Eight (5.2%) patients developed recurrences after full-thickness mesh fixation, and ten subjects (6.5%) had persistent pain in the operative area for longer than 3 months.
  
  
  CONCLUSIONS
  Full-thickness mesh fixation mechanically supports the fascia, especially in the early postoperative period, and enables homogeneous fibrous healing in a wide area, preventing mesh migration; we believe that these attributes are crucial in reducing the IH recurrence rate.
authors.affiliation: Department of General Surgery, Faculty of Medicine, Mevlana University, Konya, Turkey. drkazimgemici@hotmail.com.|, Aksinne mahallesi Esmetas sokak No:16 Meram, Konya, Turkey. drkazimgemici@hotmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Gemici
authors.affiliation: Department of Radiology, Faculty of Medicine, Mevlana University, Konya, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Acar
authors.affiliation: Department of Genetics, Faculty of Medicine, Mevlana University, Konya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Barıs
authors.affiliation: Department of Radiology, Faculty of Medicine, Mevlana University, Konya, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Yıldız
authors.affiliation: Department of Orthopaedics and traumatology, Faculty of Medicine, Mevlana University, Konya, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Sever
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Mevlana University, Konya, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Bilgi
authors.affiliation: Department of Plastic Surgery, Faculty of Medicine, Mevlana University, Konya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Sentürk
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013536:Suture Techniques; D013537:Sutures; D014945:Wound Healing
keywords: Incisional hernia; Mesh; Onlay technique; Recurrence; Seroma