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. 2017 Dec;69(4):485-491.
doi: 10.1007/s13304-017-0493-1. Epub 2017 Oct 13.

A new technique for tension-free reconstruction in large incisional hernia

Gabriele Munegato  1 , Landino Fei  2 , Michele Schiano di Visconte  3 , Danilo Da Ros  3 , Luana Moras  3 , Gabriele Bellio  3
Affiliations

A new technique for tension-free reconstruction in large incisional hernia

Gabriele Munegato et al. Updates Surg. 2017 Dec.

Abstract

In the surgical management of large incisional hernias, the main target is the closure of the abdominal wall defect on the midline without a dangerous increase in the intraabdominal pressure. In this setting, new intraperitoneal prosthesis and components separation techniques were proposed to solve this problem. Both solutions present some critical issues. A new surgical approach with a free lateral double layer prosthesis totally in polypropylene both sides (FLaPp®) is proposed to overcome this problem. This is a retrospective cohort analysis study with a prospectively collected database from two different Italian hospitals. Twenty-nine patients operated from April 2010 to December 2015 were treated using the new prosthesis. Four patients developed postoperative complications: one (3.4%) presented wound infection, two (6.9%) experienced seroma, and one had a hematoma (3.4%). No deaths were recorded. At a median follow-up of 28.5 months (IQR 22-36), no hernia relapse occurred. The application of FLaPp® mesh is a safe and feasible option that can be employed to manage Rives repair in cases of abdominal wall defects with difficult closure of the posterior plan when the conventional prosthetic meshes could be unsuitable.

Keywords: Abdominal hernia; Abdominal wall; Large incisional hernia; Mesh.

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Conflict of interest statement

Conflict of interest

Authors declares no conflict of interest

Research involving human participants and/or animals

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Figures

Fig. 1
Fig. 1
Composite FLaPp® prosthesis with double prosthetic layer (lower in polypropylene film and upper in polypropylene mesh) joined in the central part creating two free flaps. The central part is oval and measures 4 × 7 cm. The peripheral portion of the prosthesis consists of two free flaps, the size of which is adapted to the defect
Fig. 2
Fig. 2
Schematic application of FLaPp®
Fig. 3
Fig. 3
Polypropylene film flap is adapted to the shape and the size of the peritoneal defect and it is sutured to the free edges of the peritoneum with short running sutures. The polypropylene film can stay directly in contact with bowels
Fig. 4
Fig. 4
Polypropylene mesh is positioned in the area of dissection between the rectus muscles and its posterior fascia as a normal prosthesis mesh for Rives repair surgery
See this image and copyright information in PMC

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