Incisional ventral hernias: Review of the literature and recommendations regarding the grading and technique of repair

Karl Breuing, Charles E. Butler, Stephen Ferzoco, Michael Franz, Charles S. Hultman, Joshua F. Kilbridge, Michael Rosen, Ronald P. Silverman, Daniel Vargo

Research output: Contribution to journalArticle

588 Scopus citations

Abstract

Despite advances in surgical technique and prosthetic technologies, the risks for recurrence and infection are high following the repair of incisional ventral hernias. High-quality data suggest that all ventral hernia repairs should be reinforced with prosthetic repair materials. The current standard for reinforced hernia repair is synthetic mesh, which can reduce the risk for recurrence in many patients. However, permanent synthetic mesh can pose a serious clinical problem in the setting of infection. Assessing patients' risk for wound infection and other surgical-site occurrences, therefore, is an outstanding need. To our knowledge, there currently exists no consensus in the literature regarding the accurate assessment of risk of surgical-site occurrences in association with or the appropriate techniques for the repair of incisional ventral hernias. This article proposes a novel hernia grading system based on risk factor characteristics of the patient and the wound. Using this system, surgeons may better assess each patient's risk for surgical-site occurrences and thereby select the appropriate surgical technique, repair material, and overall clinical approach for the patient. A generalized approach and technical considerations for the repair of incisional ventral hernias are outlined, including the appropriate use of component separation and the growing role of biologic repair materials.

Original languageEnglish (US)
Pages (from-to)544-558
Number of pages15
JournalSurgery
Volume148
Issue number3
DOIs
StatePublished - Sep 2010

ASJC Scopus subject areas

  • Surgery

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