Technical consideration for subxiphoidal incisional hernia repair.

Abstract

BACKGROUND:

The main principle of incisional hernia repair with mesh augmentation is a wide overlap of at least 5 cm in all directions. This is complicated when cartilaginous or osseous structures border the fascial defect, most notably at the xiphoid after sternotomy or in large proximal incisional hernias.

METHOD:

We performed an anatomic investigation of this "problematic" area with its different structures and layers that form the retroxiphoidal space.

RESULTS AND CONCLUSION:

The posterior lamina of the rectus sheath inserts on the posterior side of the xiphoid. This lamina inhibits a sufficient mesh placement. By sharp dissection dorsal the xiphoid process, the posterior lamina of the rectus sheath can be detached. This way the retroxiphoidal space can be opened. Further development of this space can be made by blunt dissection. In some cases, with retroxiphoidal scar formation after sternotomy, a sharp dissection might be necessary. This enables a combined retromuscular-retroxiphoid mesh augmentation repair with a sufficient underlay of at least 5 cm, according to the principles of sublay technique.

• Authors: J Conze, A Prescher, K Kisielinski, U Klinge, V Schumpelick
• Journal: Hernia : the journal of hernias and abdominal wall surgery (Hernia) Vol. 9 Issue 1 Pg. 84-7 (Mar 2005) ISSN: 1265-4906 [Print] France
• PMID: 15257447 (Publication Type: Comparative Study, Journal Article)

Topics

• Cadaver
• Cicatrix (pathology, surgery)
• Hernia, Ventral (etiology, pathology, surgery)
• Humans
• Prosthesis Implantation (instrumentation)
• Rectus Abdominis (anatomy & histology, surgery)
• Recurrence
• Reoperation
• Surgical Mesh
• Surgical Procedures, Operative (methods, standards)
• Thorax (anatomy & histology)
• Xiphoid Bone (anatomy & histology, surgery)