Sliding Myofascial Flap of the Rectus Abdominus Muscles for the Closure of Recurrent Ventral Hernias

Abstract

Despite a reported incidence of up to 11 percent of incisional/ventral hernias following celiotomies, there is no universally applicable preventive or reconstructive technique in practice. Among patients undergoing repair of ventral incisional herniation, the reported recurrence rates are typically in the 30- to 50-percent range. This study concentrates on the patient with a large, recurrent abdominal incisional hernia in whom conventional surgical repair has failed. We report our recent 4-year experience with the use of "components separation" of the myofascial layers of the abdominal wall for repair of these recurrent herniations. During 4-year period, 35 patients with large, recurrent ventral hernias underwent repair by the same surgeon (J. H. M.) using the method described below. Abdominal defects as large as 875 cm2 were repaired, with a median defect size of 255 cm2. The repair was based on the compound flap of the rectus muscle with its attached internal oblique-transversus abdominus muscle with advancement to the midline to recreate the linea alba. Any repairs that were attenuated were supported with either ePTFE (8.6 percent) or Vicryl mesh (34 percent). The study group consisted of 35 patients, 34 percent male and 66 percent female; mean age was 55 years. Length of follow-up ranged from 1 to 43 months, with a mean follow-up of 22 months. Overall recurrence rate for herniation was 8.5 percent (3/35). Additional complications, namely seroma, wound infection, and hematoma, occurred at rates of 2.8, 5.7, and 5.7 percent, respectively. There were no mortalities. The compound flap of the rectus and internal oblique-transversus can be advanced medially to recreate the linea alba to provide dynamic, stable support for defects as large as 875 cm2. A recurrence rate of 8.5 percent was achieved in a relatively high-risk population with acceptable morbidity and no mortalities. In our 4-year experience, the sliding rectus abdominus myofascial flap has proved to be a safe and effective tool for dealing with patients in whom conventional means of repair have failed.

Autologous Tissue Reconstruction of Ventral Hernias in Morbidly Obese Patients

“…Many studies have shown that this operation is safe and effective for reconstructing complex abdominal wall defects, with recurrence rates of approximately 10%. [13][14][15][16][17][18] Among our patients, 5 (17%) had postoperative complications, which were all easily treated, and only 1 hernia (3%) recurred.…”

Extensive Pneumatosis Intestinalis in Association With Celiac Disease: A Case Report

“…The mechanical theory suggests that gas dissects into the bowel wall secondary to disruption in the mucosal integrity due to various factors such as ischemia, trauma or infection [5]. It has also been suggested that gas can tract through the tissues and along the root of the mesentery in patients with COPD [5].…”

“…The mechanical theory suggests that gas dissects into the bowel wall secondary to disruption in the mucosal integrity due to various factors such as ischemia, trauma or infection [5]. It has also been suggested that gas can tract through the tissues and along the root of the mesentery in patients with COPD [5]. The biochemical theory, on the other hand, proposes that luminal bacteria produce significant amounts of hydrogen as a result of fermentation of mostly carbohydrates, which is then forced into the bowel wall as intraluminal pressure rises.…”

Introductory Chapter: Different Types of Parietal Hernias, Diagnosis and Treatment

“…In the 1990s, Ramirez and Al [6] and Di Bello and Moore [7] already associated dermolipectomy and certain techniques of parietoplasty (in mobilisation by sections and sutures, the various musculo-aponeurotic components). They find respectively a rate of recurrence of 8 and 8.5% [8].…”