Ventral Hernia Mesh Repair

Giant omphalocele are defects larger than 10 centimeters encompassing the liver within the defect with a total loss of abdominal cavity domain. Babies born with giant omphalocele are seldom closed primarily during the neonatal due to the development of abdominal compartment syndrome, compression of the inferior vena cava  and suprahepatic veins leading to multisystemic organ failure and death. The defect is covered with some bacteriostatic ointment and the amnion left to granulate creating neoskin as simple cover. Once the defect is covered with the growing skin the hernia is closed either using a prosthetic mesh, component separation or primarily. Primary repair has a 25-52% recurrence rate and is used for small < 5 cm defect. The component separation technique (CST) enlarges the abdominal wall surface by translation of the muscular layer without compromising the blood supply and innervation of the muscles. A longitudinal cut is made in the external aponeurotic fascia lateral to the rectum encompassing closure in the midline. This can be used when closing hernias between 5 and 10 cm in diameter. CST technique has a 33% of wound complications and 30% re-herniation rate. Transection of the perforating branches of the epigastric artery interfere with the blood supply of the skin of the ventral abdominal wall who will need collaterals from the intercostal artery and pudendal artery to survive. Prosthetic material can be synthetic or biologic. Prolene is a cheap synthetic mesh that creates adhesion, erosions and fistula. Biologic mesh are biodegradable unless process like cross-linking the collagen fibers take place. This extracellular material derived from human or other mammalian animal. Broad range of size helps repair larger hernia defects. Biologic mesh minimized adhesions between the mesh and viscera and incites fibrous tissue to grow and create a tough fascia with secure fixation of the mesh to the abdominal fascia. Biologic mesh are preferred to be placed underneath the peritoneal fascia (sub-lay or underlay). Biologic mesh should be biocompatible, non-toxic and nonimmunogenic. Neither antibiotic coverage nor subcutaneous drainage has an effect in the incidence of wound-related complications when placing this mesh.  

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