title: Retro-rectus repair of complex incisional hernia leads to low recurrence rate.
abstract: BACKGROUND
  To assess the outcome of retro-rectus repair of complex abdominal wall repair (CAWR) in a single institution in relation to the use of biologic and synthetic mesh.
  
  
  METHODS
  A retrospective review was undertaken of complex abdominal wall repairs performed by a single surgical team, assessing the outcome of the retro-rectus repair and factors affecting the outcome.
  
  
  RESULTS
  Between 2007 and 2013, 57 (33 male) patients underwent CAWR retro-rectus repair. The material used was assessed as either synthetic or biologic (cross-linked porcine dermal collagen). The Ventral Hernia Working Group grades were similar between groups of patients having a repair with synthetic and biologic mesh. Median follow-up in the synthetic group was 18 months (1-80.5) and 18.4 months (0.5-70.7) in the biologic group. There was no statistical difference in seroma, wound infection or haematoma rates. No fistulae occurred in either group. Overall recurrence was 3.4% and there was no statistical difference between groups.
  
  
  CONCLUSIONS
  The retro-rectus repair technique is associated with a low rate of recurrence and is now the technique of choice. The choice of material, biologic or synthetic, in Ventral Hernia Working Group grades 1-3 remains controversial.
authors.affiliation: Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Exeter, UK.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Warwick
authors.affiliation: Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Exeter, UK.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Smart
authors.affiliation: Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Exeter, UK.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Daniels
mesh_terms: D005260:Female; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017568:Rectus Abdominis; D012008:Recurrence; D012189:Retrospective Studies
keywords: abdominal wall; biologic; hernia; incisional; mesh; recurrence