Repair of incisional hernia after median sternotomy.

About 19 000 cardiac surgical procedures are carried out annually in the United Kingdom, 4000 being for congenital defects (UK Cardiac Surgical Register: Society of Thoracic and Cardiovacular Surgeons of Great Britain and Ireland, 1983). Most of these procedures use the median sternotomy incision for access to the heart and great vessels. Epigastric incisional hernias may occur as a complication in up to 4% of these operations.' The defects occur in the subxiphoid position, where the incision enters the epigastrium. In a review of 582 consecutive median sternotomy wounds 20 incisional hernias were found. Forty per cent were symptomatic, the main complaint being of epigastric pain and discomfort exacerbated by movement. Small defects were satisfactorily repaired by standard techniques, such as a nylon darn or Mayo repair.2 Large subxiphoid defects can be successfully repaired by a modification of the Wells procedure.3