Operative Repair And Techniques

Following the steps for hernia repair outlined earlier, primary (tissue) repairs are used for small first-time repairs. Because of high recurrence rates with the primary repair, mesh is employed for larger defects and recurrent hernias (12). With open repairs, mesh may be used as an on-lay patch to buttress a repair; as an inlay patch placed anteriorly, posterior to the rectus sheath as a sandwich around the fascial planes, or in the preperitoneal space; or as an intraperitoneal on lay-patch. Particularly large and difficult repairs may be repaired using an approach popularized by Stoppa placing a large sheet of mesh placed very widely in the preperitoneal space (13). Laparoscopic approaches utilize an intraperitoneal placement of the mesh (14). Polypropylene and Dacron mesh, historically the most popular, ordinarily are not be used intraperito-neally because of the risk of a fistula to the bowel (Fig. 3).

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