Repair of complex giant or recurrent ventral hernias by using tension- free intraparietal prosthetic mesh (Stoppa technique): Lessons learned from our initial experience (fifty patients)

Background. Giant complex ventral hernias are difficult to repair, and recurrent rates are high (greater than 10%). Our aim was to review our experience with a modified Stoppa technique. Methods. From 1991 to 1995, 50 patients underwent repair with a large panel of prosthetic mesh placed intraparietally posterior to rectus muscle but anterior posterior rectus sheath; 27 had undergone one to five previous hernia repairs, and 14 patients had a simultaneous intraabdominal procedure. Mean follow-up (100%) has been 24 months. Results. No operative deaths occurred. Hospital morbidity included four wound infections, 2 of which were serious and required mesh removal; both occurred in patients in whom the gut was opened for other simultaneous intraabdominal procedures. Late morbidity included two delayed wound infection/limited mesh infections managed by office debridement and open packing, three seromas, and transient abdominal wall pain in seven patients. Long-term follow-up showed no recurrent hernias in the 48 patients without early serious mesh infections requiring mesh removal; thus the long-term success rate was 96% (48 of 50 patients). Conclusions. Recurrent rates after this modified Stoppa repair of giant complex ventral hernias are very low. Early or late mesh infection occurred in four patients. Tension-free prosthetic mesh repair offers a marked improvement in outcome. Because of the possibility of mesh infection, simultaneous; contaminated, or even clean- contaminated intraperitoneal procedures should be avoided if possible.