Rives technique is the gold stardard for incisional hernioplasty. An institutional experience.

AIM

We report our clinical experience with incisional hernia surgery and we retrospectively analyze the outcomes obtained with the different techniques of repair used, confirming that Rives-Stoppa procedures actually represent the gold standard for incisional hernia.

MATERIAL OF STUDY

334 patients were observed for incisional hernioplasty at our Department of Surgery from 1996 to 2007. They were treated according to the following surgical procedures: 44 primary direct closures; 246 Rives-Stoppa procedures; 9 Chevrel procedures; 35 intraperitoneal repairs. The outcomes were considered in terms of postoperative surgical complications.

RESULTS

In total, we had 13 cases of hernia recurrence (3.9%), 14 cases of infections (4.2%), 7 cases ofseroma/hematoma (2.9%) and one case of acute respiratory insufficiency.

DISCUSSION

The choice of the surgical technique depends on several factors, such as the size of the hernia defect and the representation of the anatomical structures, essential for the reconstruction of the abdominal wall. We abandoned Chevrel technique due to high rate of recurrence and infective complications and reserved the intra-peritoneal repair only for cases where a fascial layer could not be reconstructed. Instead, the primary direct closure should be considered for high risk patients because of its low surgical impact, although it is characterized by higher incidence of recurrence. Combining the Rives-Stoppa technique with some personal technical modifications, we obtained acceptable results in terms of recurrence rate and morbidity.

CONCLUSIONS

Rives-Stoppa procedures are the current standard of care for the surgical repair of incisional hernia and our treatment of choice.