Your preferred incisional hernia repair (if not laparscopic)

[europeman]

At my institution, generally, lap repairs are the preferred technique for incisional/ventral hernias. I know that's certainly not the case everywhere in the country.... but here's my question:

If you can't do (or don't want to) a lap repair (too many adhesions, anatomy of defect, your mood, whatever) then what kind of open repair do you prefer?

Rive Stoppa? Underlay w/gortex? Inlay? Overlay? Does ANYONE do inlays anymore?

Anyone prefer the underlay technique to stoppa here?

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[45408]

I've done a few retrorectus inlay repairs.

 

[ESU_MD]

I always liked the stoppa repair. Never understood the onlay, would you patch a tire from the outside? I miss hernia repair, in cardiac surgery i dont get to do any these days... My only contribution is to prevent hernias by never placing my mediastinal drains in the subxiphoid midline

 

[blue2000]

I always liked the stoppa repair. Never understood the onlay, would you patch a tire from the outside? I miss hernia repair, in cardiac surgery i dont get to do any these days... My only contribution is to prevent hernias by never placing my mediastinal drains in the subxiphoid midline

And the general surgeons here thank you, as those are a pain to repair.

 

[GregsAnatomy]

Rive-Stoppa. This is changing though now since we've had the ability to put in HUGE pieces of mesh laparoscopically with ease using the Echo positioning system from Bard.

 

[doc05]

stoppa. laparoscopic repairs are nonsense.

 

[europeman]

stoppa. laparoscopic repairs are nonsense.

lap repairs nonsense? I disagree.

They are wonderful procedures, particularly for obese/super-obese patients. I've had plenty of patients w/follow up of 4 years now who are very happy and were spared the huge wack of an open repair.

 

[Miami_med]

What's wrong with an underlay?

For complex ventral hernias, I've seen the best results with a components seperation and a mesh underlay. This is often biologic, but there's no real reason they need to be.

I guess my algorithm is to use some sort of open pre-peritoneal repair for small defects, laparoscopic repairs for larger hernias without a lot of adhesions and no contraindication, and the method mentioned above for more complex hernias.

It seems essentially impossible to do any sort of pre-peritoneal repair in complex hernias, They seem to do pretty well in those that are smaller with a single defect. That being said, the laparoscopic repair just seems to make so much sense that I just can't fathom choosing not use it in a patient who has a remotely sizeable defect amenable to it.