Open Onlay Mesh Repair for Major Abdominal Wall Hernias with Selective Use of Components Separation and Fibrin Sealant

Background The objective of the study was to reassess the efficacy of the open onlay technique for repair of major incisional hernias, utilizing the modern adjuncts of components separation and fibrin sealant to reduce the principal complications of seroma and recurrence. Major incisional hernias were defined as >10 cm transverse diameter. Methods A prospective audit was applied to 116 patients undergoing open onlay incisional hernia repair during a 2-year period at a single institution. Information was collected concerning operative details, postoperative complications, and recurrence. Clinical review at a median 15.2 months postoperatively was followed by a telephoned structured questionnaire to assess quality of life. All patients with pain or suspected recurrence were recalled for examination. Results Fascial closure required components separation in 21 (18.1%) patients when tension-free fascia reconstruction was not possible, and fibrin sealant was applied in 22 (18.9%) in whom extensive skin flaps were dissected beyond the semilunar line. Postoperatively, there were 11 (9.5%) seromas and 2 (1.7%) deep wound infections. At 15.2 months’ follow-up there were 4 (3.4%) recurrences. Conclusions Open onlay mesh repair for major incisional hernias is a versatile operation applicable to all quadrants of the abdominal wall and gives excellent results when used in association with components separation and fibrin sealant.