Incisional Hernia Repair: Tensiometry for the Selection of the Appropriate Procedure

OBJECTIVE: To audit the early and late results of repairs of incisional hernias before and after the introduction of peroperative tensiometry. DESIGN: Retrospective study. SETTING: University hospital, Germany. PATIENTS: 675 operations on 553 patients in 18 years. INTERVENTIONS: Before we introduced tensiometry we closed 560 incisional hernias by direct suture and 63 by the inlay-onlay technique. Since we took up tensiometry the numbers were 9 and 43, respectively. MAIN OUTCOME MEASURES: Postoperative complications including recurrences. RESULTS: Recurrences developed in 246/560 (44%) after direct suture in the early series, compared with 2/9 (22%) after adoption of tensiometry. After inlay-onlay operations there were 4/63 (6%) recurrences before, and 1/43 (2%) after adoption of tensiometry. CONCLUSIONS: Tensiometry allows the surgeon to tailor his operation to the conditions that he finds during the operation.