Modified rives-stoppa repair for abdominal incisional hernias

Incisional hernias are a prevalent problem in abdominal surgery and occur in 11% of patients who undergo laparotomy. Primary suture closure of incisional hernias results in a 31%-58% chance of recurrence. The addition of a prosthetic mesh implant decreases recurrence rates to 8%-10%. Popularized in Europe by Rives and Stoppa, the sublay technique has proven to be very effective, with low recurrence rates (0%-23%) and minimal complications. The purpose of the study was to evaluate the experience of a single surgeon at a large tertiary care center performing a modified Rives-Stoppa repair for abdominal incisional hernias. To do this, the records of all patients undergoing a modified Rives-Stoppa incisional hernia repair between January 2000 and August 2003 were retrospectively reviewed. Outpatient clinic notes, discharge summaries, operative reports, and laboratory data were reviewed for patient demographics, surgical data and postoperative complications. Univariate analysis was performed in order to identify predictors for recurrence. During the study period, 83 patients underwent a modified Rives-Stoppa incisional hernia repair. Nineteen patients were excluded due to incomplete medical records. No patients required postoperative exploration for an intra-abdominal catastrophe. Twenty-five percent (n=16) of patients had a complication as a result of the hernia repair. Only two patients (3.1%) developed recurrent incisional hernias. History of diabetes (p=0.007) and benign prostatic hyperplasia (p=0.000) were the only significant predictors for recurrence. The results presented here confirm that the modified Rives-Stoppa retromuscular repair is an effective method for the repair of incisional hernias. The complication and recurrence rates compare favorably to results for currently popular alternative techniques.