Open repair of abdominal incisional hernia

• 3cm overlap recommended (as the mesh shrinks)
• Types of mesh repair:
  • Inlay
  • Sublay / underlay / preperitoneal / “retro-rectus” placement
    • Mesh between peritoneum & fascia (or peritoneum & muscle)
    • Lowest recurrence rate
      • ? fewer complications
  • Onlay with primary closure
    • Mesh superficial to rectus, after closing rectus
• European Hernia society guidelines
  • Recommend retromuscular (retrorectus or pre-peritoneal)
    • Onlay vs retrorectus
      • Onlay - increased risk of recurrence, seroma and haematoma
        • Low quality evidence
  • Recommend against IPOM if possible to limit contact with viscera