Open mesh repair of incisional hernia using a sublay technique: long-term follow-up.

BACKGROUND: Reported results of incisional hernia repair are poor with high recurrence rates unless prosthetic mesh is used. Mesh gives improved results, but certain techniques are associated with a high incidence of infections, fistulas, and seromas. This study reports the results of a consecutive series of incisional hernias repaired using an open sublay technique with retromuscular mesh placement. The primary endpoint was hernia recurrence. Secondary endpoints were complications and long-term discomfort.

METHODS: A total of 125 patients were operated on between 1991 and 2001. In 2002 they were sent a questionnaire and asked to return for examination if they thought their hernia had recurred or if they had pain. A second questionnaire was sent in 2005, and all patients were asked to return for examination.

RESULTS: There were no postoperative deaths and no major systemic complications. There were no early (within 30 days) wound infections; the mesh subsequently became infected in two patients and had to be removed. Seromas developed in 12 patients. In 2002, a total of 106 questionnaires were returned; 3 patients had died of unrelated causes, and 16 were untraceable despite repeated attempts. There were five (4%) recurrences. Altogether, 6 patients had abdominal wall discomfort, and 49 patients spontaneously wrote that they were pleased or very pleased with the long-term result. At a second follow-up a mean of 8 years after operation (95 months; range 46-168 months) patients were assessed by an independent observer, and there were no further recurrences.

CONCLUSIONS: Open repair of incisional hernias with mesh in the subfascial plane is highly effective with acceptable complication rates. Surgeon experience and a team approach are important factors in obtaining good results. Trials comparing open with laparoscopic repair are needed.