Revisiting the Anterior Rectus Sheath Repair for Incisional Hernia: A 10-Year Experience.

Abstract

Surgeons continue to seek an incisional hernia repair technique which minimizes cost and morbidity while maximizing durability. We present a single surgeon's experience with a technique described by N.L. Browse and J.P. Chevrel in 1979. The Chevrel/Browse repair consists of a bilateral anterior rectus sheath release, hernia sac imbrication, bilateral rectus complex medialization, and repair reinforcement with an anterior prosthetic mesh. Data were collected on all patients who underwent herniorrhaphy between April 2003 and April 2013. A total of 123 patients underwent repair. These had undergone an average of 2.6 prior abdominal operations and 0.7 prior hernia repairs; the average defect size was 64.77 ± 86.79 cm². Twelve patients had lateral components release in addition to release of the anterior rectus sheath to achieve midline re-approximation with minimal tension. Synthetic mesh was used in 81 % of repairs and biologic mesh in 19 %. The most common complications were seroma formation (21 %) and incisional skin breakdown (30 %); no deaths occurred. The overall recurrence rate was 5.1 %, and 7 % for the group which had follow-up greater than 36 months. Use of biologic mesh increased the rate of seroma formation compared with synthetic mesh (50 vs. 14 %, p < 0.001), but did not increase the rate of wound breakdown (36.3 vs. 29.6 %, p = 0.72). This case series describes the utilization of anterior rectus sheath release and mesh placement which is anterior to the rectus muscle. Hernia recurrence and intra-abdominal complications are observed to be uncommon after repair using this technique. Future prospective randomized studies are warranted.