Abstract. A series of 68 primary midline incisional hernias with a verticalMayo repair was evaluated retrospectively. Patients without documented hernia recurrence following this repair were invited for physical examination. Life-table methods were used for statistical analysis. The 1-, 3-, 5-, and 10-year cumulative recurrence rates were 35%, 46%, 48%, and 54%, respectively. Also, generally accepted risk factors were studied. Multivariate analysis identified the size of the hernia (p ؍ 0.02) and the use of steroids (p ؍ 0.04) as the most important independent risk factors of first time recurrent incisional hernia. Considering the high recurrence rates found, the results of this study strongly suggest that the vest-over-pants repair should no longer be used for closure of midline incisional hernias.Incisional hernias appear in at least 10% of patients with midline laparotomies [1]. Patients with an incisional hernia often complain of the aesthetic appearance or suffer from discomfort, pain, or intestinal obstruction [2]. A variety of operative procedures for incisional hernia repair have been in use, but the results are often disappointing. Five-year cumulative recurrence rates as high as 41% have been reported [3].Mayo believed that a scar in one plane, from within out, was an important risk factor for developing a hernia [4, 5]. He therefore advocated an overlapping repair in which each line of sutures is protected by normal structures. These sutures hold the structures in apposition, and the intraabdominal tension itself prevents displacement [4]. Mayo's technique is considered to be a major step in the history of hernia repair. Formerly, surgeons attempted to unite extensively dissected rectus muscles vertically in the midline, with poor results [4].The present study was performed to evaluate the results of the vertical "vest-over-pants" Mayo repair. In addition, various potential risk factors for recurrent incisional hernia were analyzed.
Patients and MethodsThe records of all patients with a vertical Mayo repair operated at the Department of Surgery of the Sint Franciscus Gasthuis Rotterdam between 1981 and 1990 were reviewed retrospectively. Because recurrent hernias are known to have higher recurrence rates [3, 6] and incisional hernias occur more often in the midline than in other vertical [1,[7][8][9] or transverse [7, 10 -14] incisions, only patients with a primary hernia of the midline were selected for analysis. Patient-related factors of sex, age, obesity, chronic cough, prostatism, constipation, diabetes mellitus, history of oncologic disease, and use of steroids were noted. Obesity was measured using the Quetelet index. Operation-related factors, including surgical technique, suture materials, wound hematoma, wound infection, and the surgeon's experience (resident, consultant), were also analyzed. Hernia-related factors, such as the hernia-free interval, type of incision, previous hernia repairs, and the size and number of the hernias, were evaluated as well. Midline hernias were divided in...
