Friday, April 20, 2012


I often use mesh to repair large incisional hernias. But, not every patient with a large incisional hernia needs mesh. A young patient, for example, may be better served with hernia repair without mesh, especially if you think you may have to enter the abdomen again. 

The young girl pictured here presented with intraabdominal sepsis following an abortion. She was extremely ill. We explored her and found a perforated uterus and generalized peritonitis. We packed the abdomen and stabilized the patient then returned after 36 hours. The abdomen was still grossly contaminated so we repeated the process. On the third laparotomy, the abdomen looked improved but the bowel was quite swollen and closure was impossible. We raised skin flaps and closed the skin leaving a large fascial defect. The patient improved but deteriorated after about 1 week. I suspected a subphrenic abscess since she had hiccups. We reexplored her and that is what we found. The abscess was drained and the abdomen closed and she recovered!

Component Separation-note release of external oblique muscle
After 3 months, she returned wanting her hernia repaired. She looked good and had gained weight but I wanted her to recover further.  I told her to go home and eat 6 eggs per day and I would reevaluate her in 3 months. After 6 months we  repaired her large defect using the Component Separation Technique. She had an uneventful recovery with a strong abdominal wall.

Component Separation-the external oblique muscle is separated from
the internal oblique. This allows the rectus muscle to be advanced.