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21.08.2018 | Original Scientific Report with Video | Ausgabe 1/2019

World Journal of Surgery 1/2019

Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study

World Journal of Surgery > Ausgabe 1/2019
Miguel Ángel García-Ureña, Javier López-Monclús, Diego Cuccurullo, Luis Alberto Blázquez Hernando, Providencia García-Pastor, Stefano Reggio, Elena Jiménez Cubedo, Carlos San Miguel Méndez, Arturo Cruz Cidoncha, Alvaro Robin Valle de Lersundi
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00268-018-4765-9) contains supplementary material, which is available to authorized users.



Optimal mesh reinforcement for abdominal wall reconstruction (AWR) in complex hernias remains questionable. Use of biologic, absorbable and synthetic meshes has been described. The idea of using an absorbable mesh (AM) under a permanent mesh (PM) in a retromuscular position may help in these challenging situations.


Between 2011 and 2016, consecutive patients undergoing open AWR utilizing an AM as posterior layer reinforcement and configuration of a large PM were identified in a multicenter prospectively maintained database in four hospitals. Main outcomes included demographics, ventral hernia classifications, perioperative data, complications and recurrences.


A total of 169 complex incisional hernias were analyzed. Mean age was 60.9, with mean body mass index 30.7 (range: 20–46). Location of incisional hernias (IH) was: 80 midline, 59 lateral and 30 midline and lateral. 78% were grade I and II in Ventral Hernia Working Group classification. 52% of patients were discharged with no complication. There were 19% seromas, 13% hematomas, 12% surgical-site infection and 10% skin dehiscence. Only partial mesh removal was necessary in one patient. After a mean follow-up of 26 months (range 15–59), there were five (3.2%) recurrences. Reoperations on patients showed a band of fibrosis separating the peritoneum from the PM.


The combination of AM with very large PM in the same retromuscular position in AWR seems to be safe. The efficacy with recurrence rates below 4% in complex midline and lateral IH may be explained by the use of larger PMs that are extended and configured with the support of AMs. Reoperations on patients have confirmed the previous experimental reports on the use of the AM.

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3D-configuration of a large PM with the support of AM after a left TAR and right Rives in a large iliac incisional hernia (MP4 55,539 kb)
Stoppa configuration and extension of a large PM after a bilateral TAR in a complex midline incisional hernia (MP4 28,417 kb)
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