Hernioplastia con Malla Técnica Preperitoneal Retrofascial en Hernia Incisional Recurrente

La técnica de corrección de hernias incisionales recurrentes con instalación de malla retrofascial y preperitoneal fue utilizado por un grupo quirúrgico de Carolina del Norte y fue publicado en el Journal of the American College of Surgeons. Muestran buenos resultados. Otro detalle es que la mayoría de los pacientes son obesos.

Open Preperitoneal Retrofascial Mesh Repair for Multiply Recurrent Ventral Incisional Hernias
Yuri W. Novitsky MDa, Justin R. Porter BAa, Zach C. Rucho BAa, Stanley B. Getz MD, FACSb, Broc L. Pratt MDb, Kent W. Kercher MD, FACSa and B. Todd Heniford MD, FACSa, aCarolinas Hernia Center, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NCbDepartment of Plastic Surgery, Carolinas Medical Center, Charlotte, NC.

Background
Because herniorrhaphy failure and complication rates appear proportional to the number of previous repairs, multiply recurrent hernias (MRH) represent a formidable challenge. We sought to determine the safety and efficacy of open preperitoneal retrofascial mesh repair of MRH.
Study design
We conducted a retrospective review of consecutive patients undergoing an open preperitoneal retrofascial mesh repair of multiply (two or more) recurrent hernias at a tertiary care referral center.
Results
From January 2001 to May 2005, 128 patients underwent surgical repair of an MRH; 32 of these underwent an open preperitoneal repair. The average body mass index was 39.1 ± 8.4 kg/m2 (range 28.9 to 61.0 kg/m2). All patients had significant comorbidities; 18.8% were smokers. The number of previous herniorrhaphies was 3.6 (range 2 to 24). Polypropylene mesh was used in all patients, including lightweight polypropylene in 10 (31.2%) patients. The average mesh size was 937 ± 531 cm2 (range 225 to 1,800 cm2). There were no major intraoperative complications. Wound infection occurred in 4 patients (12.5%, all smokers), requiring partial mesh excision in 1 patient. Univariate analysis revealed smoking as the only predictor of wound or mesh-related morbidity (p = 0.0004). At a mean followup of 28.1 months (range 8 to 60 months), there has been 1 recurrence (3.1%) in the patient requiring partial mesh removal.
Conclusions
Open preperitoneal retrofascial mesh repair resulted in an effective herniorrhaphy with low perioperative morbidity in patients with MRH. Smoking cessation appears to be important in minimizing infectious complications. Given the technical challenge, surgical care of patients with MRH may be best provided in referral centers with interest and expertise in complex hernia repairs