COMBINED ABDOMINOPLASTY WITH ABDOMINAL WALL HERNIAS REPAIR

Abstract

Abdominal wall hernias complicate between 5% and 11% of abdominal surgery procedures. The repair of these massive ventral hernias remains a challenging problem for surgeons. Many surgeons discourage abdominal wall reconstruction because of the technical difficulties, the high morbidity, and the relatively high recurrence rate associatedwith this procedure. Primary repair is rarely successful, with recurrence rates ranging from 18% to 62% depending on the defect size. If synthetic mesh is added, recurrence rates drop significantly to between 2% and 32%.However, many patients with large hernias have invalidating symptoms, such as bulging of the abdominal wall, chronicwounds, immobility, and back pain, which require surgical treatment. The options the surgeon has are open primary repair, open repair with mesh, laparoscopic repair, or autologous tissue transfer or mobilization. The use of autologous tissue to repair abdominal wall hernias has been described. The tensor fascia lata, Sartorius and rectus femoriscan be used as either free flaps or pedicled flaps to close large defects. However, the lack of sufficient tissue may require the insertion of prosthetic material or transposition of autologous material to bridge the fascial gap. Reconstruc-tion using preperitoneally placed prosthetic material is still the most frequently used reconstruction method.Theincreased risk of infection in case of wound complications is a relative contraindication against the use of prosthetic materials.