[Conceptual reformulation of the double mesh repair technique: a simple solution for highly complex abdominal wall defects].

INTRODUCTION: Repair of complex abdominal wall defects remains a challenge for the general surgeon. The aim of the present study was to validate the double mesh repair technique in complex hernias.

MATERIAL AND METHOD: We performed a prospective study of 15 patients with complex abdominal wall defects who underwent surgery in a university hospital. All patients were evaluated in a multidisciplinary unit. Indications consisted of incisional hernias with multiple recurrences (> 3 times), prior mesh complicated by fistula and chronic infection, giant diffuse lumbar hernia, and ventral hernia (associated with parastomal hernia or occurring after bariatric surgery with associated dermolipectomy). The surgical technique used was double intra-abdominal and supra-aponeurotic mesh repair without associated plasty techniques. Clinical, surgical and follow-up data were analyzed.

RESULTS: Nine defects were lateral, three were lumbar, one was parapubic, and two were located in the mid-line (one associated with giant parastomal hernia and one occurring after bariatric surgery). Eight showed significant tissue loss, five showed trophic skin lesions, and two showed chronic suppurative infection. The mean size of the defects was 17.5 cm. Seroma occurred in three patients and limited cutaneous necrosis occurred in one patient. The mean length of hospital stay was 4.3 days (range 2-7 days). No complications, recurrences or mortality were detected during follow-up.

CONCLUSION: Complex abdominal wall defects can be corrected through double repair using mesh only. This technique is simple to learn and perform and can be applied in many anatomical sites and types of defect, as well as in the presence of tissue destruction.