Incisional hernia repair techniques for the abdominal wall]

Incisional hernia repair has been the subject many publications over the last century. Suture techniques in one plane (Judd, 1912) or in several planes (Quenu, 1896) were described first. They remain suitable for the closure of small incisional hernias. Rectus abdominis sheath dissection techniques, also known as fascioplasties, then reinforced hernia repair by prolonging the anterior (Welti-Eudel, 1941) or posterior leaflet (Gibson, 1920) of the sheath. These plasties are still widely used, either alone, to repair medium-sized hernial orifices, or in combination with a prosthesis to repair large hernial orifices. Autologous tissues, such as fascia graft (Mac Arthur, 1901) or skin graft (Gossec, 1949) are now used because of the marked capacity of prostheses for secondary distension and their sensitivity to infection. Flaps, especially the tensor fasciae latae flap (Nahai, 1974), are indicated in infraumbilical incisional hernias in a septic context. Currently, only reinforcement prostheses can achieve lasting repair of large incisional hernias. Some teams still use intraperitoneal mesh implantation, but most teams prefer extraperitoneal implantation, generally associated with fascioplasty. Extraperitoneal mesh may be placed in a pre-musculo-aponeurotic or retromuscular position. Based on their experience, the authors opted for a pre-fascio-aponeurotic retromuscular prosthesis. They describe in detail the technique used and the results obtained based on the analysis of a series of 252 patients.