Open Mesh Repair

Summary: Background: Confronted with the fact that the onset of an incisional hernia is due to a biological problem of stable scar tissue formation, the mesh techniques today are the methods of choice for incisional hernia repair. Methods: In a retrospective study open mesh repair is reviewed, analysing the current literature. Results: Polypropylene is the material widely used for open mesh repair. New developments have led to low-weight, large-pore polypropylene prostheses, which are adjusted to the physiological requirements of the abdominal wall and permit proper tissue integration. These meshes allow the formation of a scar net instead of a stiff scar plate and therefore help to avoid formerly known mesh complications. The ideal position for the mesh seems to be the retromuscular, sublay position where the force of the abdominal pressure holds the prosthesis against the deep surface of the muscles. The lowest incidence rates of recurrence have been published for the retromuscular sublay repair. Even after long-term follow-up, recurrence rates around 10 % are possible. An analysis of the failures after open mesh repair reveals that an inadequate mesh size with no sufficient overlap at the edges is the main reason of recurrence. Therefore, an overlap of at least 5 cm in all directions should be mandatory. Conclusions: In conclusion, open mesh repair using modern, low-weight polypropylene meshes with the retromuscular sublay technique achieves excellent results for the treatment of incisional hernias even in the long-term follow-up.