Rives technique is the gold stardard for incisional hernioplasty.


COD: 04_2011_313-318 Categorie: ,

Angelo Forte, Antonio Zullino, Simone Manfredelli, Gioacchino Montalto, Francesco Covotta, Piergiorgio Pastore, Marcello Bezzi

Ann. Ital. Chir., 2011 82: 313-317

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AIM: We report our clinical experience with incisional hernia surgery and we retrospectively analyze the outcomes obtained
with the different techniques of repair used, confirming that Rives-Stoppa procedures actually represent the gold standard
for incisional hernia.
MATERIAL OF STUDY: 334 patients were observed for incisional hernioplasty at our Department of Surgery from 1996
to 2007. They were treated according to the following surgical procedures: 44 primary direct closures; 246 Rives-Stoppa
procedures; 9 Chevrel procedures; 35 intraperitoneal repairs. The outcomes were considered in terms of postoperative surgical
RESULTS: In total, we had 13 cases of hernia recurrence (3.9%), 14 cases of infections (4.2%), 7 cases of seroma/hematoma
(2.9%) and one case of acute respiratory insufficiency.
DISCUSSION: The choice of the surgical technique depends on several factors, such as the size of the hernia defect and
the representation of the anatomical structures, essential for the reconstruction of the abdominal wall. We abandoned
Chevrel technique due to high rate of recurrence and infective complications and reserved the intra-peritoneal repair only
for cases where a fascial layer could not be reconstructed. Instead, the primary direct closure should be considered for
high risk patients because of its low surgical impact, although it is characterized by higher incidence of recurrence.
Combining the Rives-Stoppa technique with some personal technical modifications, we obtained acceptable results in terms
of recurrence rate and morbidity.
CONCLUSIONS: Rives-Stoppa procedures are the current standard of care for the surgical repair of incisional hernia and
our treatment of choice.