The modern management of incisional hernias

#### Summary points Before the introduction of general anaesthesia by Morton in 1846, incisional hernias were rare. As survival after abdominal surgery became more common so did the incidence of incisional hernias.1 Since then, more than 4000 peer reviewed articles have been published on the topic, many of which have introduced a new or modified surgical technique for prevention and repair. Despite considerable improvements in prosthetics used for hernia surgery, the incidence of incisional hernias and the recurrence rates after repair remain high. Arguably, no other benign disease has seen so little improvement in terms of surgical outcome. #### Sources and selection criteria We searched PubMed from 1970-2012 and Embase and the Cochrane Library from inception using the terms “hernia” and “incisional” (using the Boolean operator AND) and “ventral” (using the Boolean operator OR). The reference lists were also used to identify studies of interest. Both authors independently identified publications for inclusion and differences were resolved by discussion. We gave priority to research published in the past five years and highly regarded older publications. Unlike other abdominal wall hernias, which occur through anatomical points of weakness, incisional hernias occur through a weakness at the site of abdominal wall closure. Why, unlike primary abdominal wall hernias, are the results after repair so poor? Perhaps it is because in the repair of incisional hernias several problems need to be overcome: a multilayered wall structure of different tissue properties in constant motion has to be sutured; positive abdominal …