Double-mesh technique abdominal wall reconstruction for severe rectus diastasis and ventral hernia repairs (two for two)

Introduction
Standard rectus plication techniques may not suffice for severe cases of rectus diastasis, especially with ventral hernia. In our study, prosthetic subfascial sublay mesh and onlay mesh may facilitate the repair of severe rectus diastases, especially with concomitant ventral hernias. There is little agreement about the most appropriate technique to repair these defects, in spite of the fact in the prevalence of ventral hernias we are often faced with reinforcement with prosthetic meshes. In the component separation technique, we found high unaccepted recurrence rate. In an attempt to reduce recurrences, we attempt to use sublay mesh and onlay mesh to inforce the defect and prevent or to decrease the recurrence. Our objective was to determine prosthetic mesh practice patterns of onlay and sublay reconstructive methods regarding indications.
Patients and methods
A total of 32 consecutive patients who underwent abdominal wall reconstruction by means of component separations associated with polypropylene mesh were included. A technique of placing mesh in a sublay manner, deep to the rectus muscles without anterior dissection of rectus abdominis from anterior sheath to avoid damage of its blood supply and damage deep umbilical perforators during dissection ended by onlay mesh on anterior rectus sheath, was applied. The complications were recorded and follow-up data were obtained after double-mesh technique.
Aim
To use prosthetic polypropylene mesh sublay (above or anterior to the posterior rectus sheath) with another onlay mesh (above the anterior rectus sheath) for rectus diastasis with or without ventral hernia.
Results
From May 2016 to January 2018, we had 16 patients who underwent cosmetic abdominal repair either for a ventral hernia repair with mesh or a rectus diastasis repair with mesh. Three patients had (isolated) rectus diastasis alone. The mean age of the patients was 55 years, with a range of 35–75 years of age. Overall, 92% of the patients were female. The mean;Deg;BM;Deg;I of the patients was 32 kg/m (range: 25–40 kg/m). There were no surgical-site infections but three surgical-site occurrences − seromas, which were treated with drainage in the office. After an average of 365 days of follow-up, none of the patients had recurrence of a bulge or a hernia.
Conclusion
This study used a double-mesh reinforcement procedure, with a low rate of recurrence and occurrences. Moreover, the repair of a large, complex hernia by double-mesh repair technique augmented with polypropylene onlay mesh and sublay results in lower recurrence rates compared with historical reports of component separation technique alone.