Combined fascia and mesh closure of large incisional hernias

Background: Incisional hernias are common and recurrence after repair has been reported in up to 44% of patients. Large incisional hernias of the abdominal wall represent substantial defect of supportive tissues. Methods: Twenty-nine patients with large incisional hernias underwent surgery from January 2003 through December 2005. Herein, we presented our experience in closure of large incisional hernias using a technique in which we combine a fascia with a prosthetic repair. The variables recorded were classified as patient-related (gender, age, obesity, cough, constipation, diabetes mellitus, glucocorticosteroid therapy, smoking habit, and abdominal surgical history) and operation-related factors (size of defect, recurrence, wound infection, hematoma, and duration of hospital stay). Results: The repair was performed for 25 midline hernias and four large incisional hernias in the right subcostal region. Four patients were females and 25 were males with a mean age of 52 (range: 30 - 77) years. The mean size of fascial defect was 12.7x4.5 cm. The mean time of operation was three hours and 18 minutes. The mean hospital stay was six (range: four to ten) days. Two patients had recurrence during the follow-up period. The mean follow-up period was 16 (range: eight to 26) months. Conclusion: The combined three-layer fascia and mesh repair can be successfully used for large incisional hernias.