What Do We Know About the Chevrel Technique in Ventral Incisional Hernia Repair?

Abstract

Introduction: In publications on ventral incisional hernia repair, the Chevrel technique and the onlay operation are often equated. This present review now aims to present the difference between these surgical techniques and analyze the findings available on the Chevrel technique. Materials and Methods: A systematic search of the available literature was performed in January 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, as well as a search of relevant journals, books, and reference lists. Thirty-four publications were identified as relevant for this review. For assessment of the Chevrel-technique with other surgical procedures there are no randomized controlled trials, prospective or retrospective comparative studies available but only case series. In the majority of case series the follow-up procedure is not reported. Results: In the onlay technique the defect is closed with direct suture or it is omitted altogether. Whereas, in the Chevrel technique this is done with sliding myofascial flaps harvested from the rectus sheaths. In the few case series available this appears to result in a lower recurrence rate for the Chevrel technique compared with the onlay technique. However, the rates of postoperative complications, surgical site occurrences (SSOs), surgical site infections (SSIs), seroma, and skin necrosis are as high as in the onlay technique. The reason for this is that both techniques require subcutaneous undermining with severance of perforator vessels. Conclusion: If mesh placement in onlay position has been chosen for specific reasons, preference can be given to the Chevrel technique over the standard onlay technique, although the study quality is limited.

Enhanced-view totally extraperitoneal repair in a morbidly obese patient with epigastric and umbilical hernias in combination with rectus diastasis: A case report

“…Claus et al reported that the subcutaneous onlay laparoscopic approach, also called the SCOLA, was a safe, reproducible, and effective alternative for minimally invasive surgery for patients with abdominal wall hernias associated with a rectus diastasis [ 17 ]. However, such onlay repairs require subcutaneous undermining, which leads to reduced perfusion of the skin flaps, resulting in wound complications including surgical site infections, seromas, and skin necrosis [ 18 ]. For morbidly obese patients, Oleck et al suggested that sparing the epigastric artery perforator was key to reducing the risk of postoperative wound complications in open ventral hernia repair for patients with a BMI of greater than or equal to 40 kg/m 2 [ 19 ].…”

Evaluation of the double mesh and intraperitoneal onlay mesh techniques in giant incisional hernias

“…Among these methods, the component separation technique has necessitated the addition of single-and doublemesh placements because the technique created new weak spots and was associated with increased postoperative morbidity. The addition of mesh placement resulted in reduced morbidity and recurrence rates [7,12]. The Expert Consensus Guided by Systematic Review has stated that the use of IPOM may be beneficial in the repair of large incisional hernias [13].…”

Evaluation of Double Mesh Modification of Chevrel’s Technique in Management of Midline Incisional Hernia

“…The two techniques differ in operative details: in Chevrel's technique, the defect is closed with sliding myofascial flaps obtained from incision of the anterior layers of rectus sheaths (18). A common feature of both techniques is placement of the mesh in the onlay position on the fascia (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Previous studies reported a high wound complication rate after the original Chevrel's technique as well as for the other onlay techniques that include skin necrosis, seroma formation and wound infection, which was attributed to the extensive subcutaneous dissection to facilitate overlap of the mesh beyond the lateral border of the rectus abdominis muscles.…”