Surgical Treatment of Large Multi-recurrent Incisional Hernias by Substitution Alloplasty

The surgical treatment of multi-recurrent large incisional hernias represents a problem of medical actuality which still requires studies and interpretations, meant to clarify the most correct therapeutic behavior to obtain the best results. Important progress has been made in this field by solving the principles of the surgical treatment based on more precise notions of anatomy and physiology and by knowing and interpreting the physical laws lying at the basis of the abdominal wall unbalance in incisional hernias.This paper is based on the experience of the Surgical Clinic I of Timiooara, on 350 cases (47.62%) of large and very large incisional hernias, 17.70% of which being multi-recurrent, solved by means of the alloplastic method. The election indication of the substitution synthetic prostheses in large parietal defects was based on the principle of avoiding the rise of the intra-abdominal pressure with repercussions on the diaphragm and avoiding tension in the parietal tissues, noxious factors in the production of respiratory failure and recurrences.The achievement of these requirements was possible by using synthetic meshes as substitution elements for the parietal defects. The Dacron (Mersilene), polypropylene (Marlex) and indigenous Plastex meshes provided good results by a moderate inflammatory reaction, adequate mechanical resistance, good elasticity and satisfactory biocompatibility. It results from the study that the substitutional alloplasty in large and/or recurrent incisional hernias represents a therapeutic progress, the postoperative results being good in more than 90% of the cases.