Description

Ventral hernias refer to fascial defects of the anterolateral abdominal wall through which intermittent or continuous protrusion of abdominal tissue or organs may occur. They are either congenital or acquired. In adults, more than 80 percent of ventral hernias result from previous surgery hence the term incisional hernias. They have been reported to occur after 0 to 26 percent of abdominal procedures. Although these hernias mostly become clinically manifest between 2 to 5 years after surgery, studies have shown that the process starts within the first postoperative month. They are said to occur as a result of a biomechanical failure of the acute fascial wound coupled with clinically relevant impediments to acute tissue repair and normal support function of the abdominal wall. Historically, incisional hernias have been repaired with either primary suture techniques or placement of a variety of prosthetic materials. Before the 1960s, most ventral hernias were repaired primarily with suture and a few with metallic meshes. Even with some modifications, recurrence rates with the primary suture repair ranged from 24 to 54 percent. The introduction of polypropylene mesh repair by Usher in 1958 opened a new era of tension-free herniorrhaphy. Recurrence rates with prosthetic mesh decreased to 10 to 20 percent. Subsequently, it was realized that the placement and fixation of the mesh were more crucial in determining the outcome of the repair. The placement of the mesh in the preperitoneal, retro muscular position with a wide overlap of at least 5 cm over the hernia defect in all directions was introduced in the late 1980s. The refinement of this method decreased the recurrence rates to as low as 3.5 percent making it to be declared the standard of care of ventral hernias. However, implantation of the mesh by open techniques requires a wide dissection of soft tissue contributing to an increase in wound infection and wound-related complications.