TENSION FREE FASCIAL REPAIR OF HUGE VENTRAL HERNIA REINFORCED BY POLYPROPYLENE MESH

Aim: Huge ventral hernias were and still a major challenging surgical condition. This study was a trial to evaluate tension 
free fascial repair reinforced by on-lay non-absorbable polypropylene mesh repair of huge ventral hernias without excision of the hernial sac. 
Methods: Twenty patients, presented with huge ventral hernias were included in the study. Designed elliptical longitudinal incision followed by meticulous dissection without interruption of the hernial sac was done. A longitudinal incision was done at the anterior rectus sheath bilaterally. Each flap of the anterior rectus sheath was reflected medially and stitched with the other flap, preferably with double breasting of the flaps. A large polypropylene mesh was then used to cover the whole dissected area and stitched at least 5 cm from any rectus sheath incisions. 
Results: All patients were followed up for at least 6 months. Except for only 2 (10%) minor necrosis of the medial edge of the abdominal wall flaps, no minor or major complications occurred. Also no recurrences occurred throughout the length of the study. 
Conclusion: This study concluded that tension free fascial repair using the anterior layer of the rectus sheath reinforced by on-lay polypropylene mesh is a good, relatively easy method of repair of huge ventral hernias.