50 × 50cm Mesh in the Treatment of Complex Abdominal Hernias: Our Hospital Experience

Background Repair for giant and/or complex hernias is a challenge that often needs complex abdominal wall reconstruction techniques and big size meshes to achieve a functional reconstruction with low recurrence. The outcomes of using one big size mesh instead of two meshes is poorly described in the literature and therefore the aim of this retrospective study. Methods Retrospective analysis of all patients with complex hernia treated at our hospital between May 2021 and December 2023 in which a polypropylene 50 × 50 cm mesh was used. Results There were a total of 32 patients. The median age, BMI and Cedar’s calculation were 67 years, 29,1 kg/m2 and 32%. 28% of the cases were recurrences. The hernias were mostly (81%) on the middle line, there were 2 lateral hernias and 4 cases with both. The average CT imaging measurement of the transverse defect and hernia volume was 11,6 cm and 875 cc3. In 22 cases Botulinum Toxin was used preoperatively and in 5 cases progressive pneumoperitoneum was added. 22 patients needed a bilateral TAR but in 9 patients an unilateral TAR was sufficient for adequate abdominal reconstruction. There was only 1 major complication that needed re-intervention (hemorrhage), 2 seromas and 1 wound infection. No recurrences were observed with a median follow-up of 11,2 months. Conclusion There is limited information regarding big size meshes in the treatment of incisional hernias. At our hospital, their use has a low percentage of complications and no recurrences. However, prospective multicenter studies are required for further validation and a longer follow-up.