ABSTRACT Incisional hernias are a prevalent problem in abdominal surgery and occur in 11% of patients who undergo laparotomy. Primary suture clo-sure of incisional hernias results in a 31%-58% chance of recurrence. The addition of a pros-thetic mesh implant decreases recurrence rates to 8%-10%. Popularized in Europe by Rives and Stoppa, the sublay technique has proven to be very effective, with low recurrence rates (0%-23%) and minimal complications. The pur-pose of the study was to evaluate the experi-ence of a single surgeon at a large tertiary care center performing a modified Rives-Stoppa re-pair for abdominal incisional hernias. To do this, the records of all patients undergoing a modi-fied Rives-Stoppa incisional hernia repair be-tween January 2000 and August 2003 were ret-rospectively reviewed. Outpatient clinic notes, discharge summaries, operative reports, and laboratory data were reviewed for patient demographics, surgical data and postoperative complications. Univariate analysis was per-formed in order to identify predictors for recur-rence. During the study period, 83 patients un-derwent a modified Rives-Stoppa incisional hernia repair. Nineteen patients were excluded due to incomplete medical records. No patients required postoperative exploration for an in-tra-abdominal catastrophe. Twenty-five percent (n=16) of patients had a complication as a result of the hernia repair. Only two patients (3.1%) developed recurrent incisional hernias. History of diabetes (p=0.007) and benign prostatic hy-perplasia (p=0.000) were the only significant predictors for recurrence. The results presented here confirm that the modified Rives-Stoppa retromuscular repair is an effective method for the repair of incisional hernias. The complica-tion and recurrence rates compare favorably to results for currently popular alternative tech-niques.
Cite this paper
nullNau, P. , J. Clark, C. , Fisher, M. , Walker, G. , Needleman, B. , Ellison, E. and Muscarella, P. (2010) Modified rives-stoppa repair for abdominal incisional hernias. Health, 2, 162-169. doi: 10.4236/health.2010.22024.
 Mudge, M. and Hughes, L.E. (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg, 72, 70–71.
Petersen, S., Henke, G.., Freitag, M., Faulhaber, A. and Ludwig, K. (2001) Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg, 167, 453–457.
Read, R.C., and Yoder, G. (1989) Recent trends in the management of incisional herniation. Arch Surg, 124, 485–488.
Rives, J., Lardennois, B., Pire, J.C. and Hibon, J. (1973) [Large incisional hernias. The importance of flail abdo-men and of subsequent respiratory disorders]. Chirurgie, 99, 547–563.
George, C.D. and Ellis, H. (1986) The results of inci-sional hernia repair: a twelve year review. Ann R Coll Surg Engl, 68, 185–187.
Langer, S. and Christiansen, J. (1985) Long-term results after incisional hernia repair. Acta Chir Scand, 151, 217–219.
Luijendijk, R.W., Lemmen, M.H., Hop, W.C. and Were- ldsma, J.C. (1997) Incisional hernia recurrence following "vest- over-pants" or vertical Mayo repair of primary her-nias of the midline. World J Surg, discussion 66, 21, 62–65.
Manninen, M.J., Lavonius, M. and Perhoniemi, V.J. （1991) Results of incisional hernia repair. A retrospec-tive study of 172 unselected hernioplasties. Eur J Surg, 157, 29–31.
Stevick, C.A., Long, J.B., Jamasbi, B. and Nash, M. (1988) Ventral hernia following abdominal aortic recon-struction, Am Surg, 54,287–289.
van der Linden, F.T. and van Vroonhoven, T.J. (1988) Long-term results after surgical correction of incisional hernia, Neth J Surg, 40, 127–129.
Cassar, K. and Munro, A. (2002) Surgical treatment of incisional hernia, Br J Surg, 89, 534–545.
Korenkov, M., Sauerland, S., Arndt, M., Bograd, L., Neugebauer, E.A. and Troidl, H. (2002) Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia, Br J Surg, 89, 50–56.
Liakakos, T., Karanikas, I., Panagiotidis, H. and Dendri-nos, S. (1994) Use of Marlex mesh in the repair of recur-rent incisional hernia. Br J Surg, 81, 248–249.
Molloy, R.G., Moran, K.T., Waldron, R.P., Brady, M.P. and Kirwan, W.O. (1991) Massive incisional hernia: ab-dominal wall replacement with Marlex mesh. Br J Surg, 78, 242–244.
Crosthwait, R.W. (1960) Ventral hernia: a rapid method of repair. Am J Surg. 99, 330–331.
Usher, F.C., Ochsner, J. and Tuttle Jr., L.L. (1958) Use of marlex mesh in the repair of incisional hernias. Am Surg, 24, 969–974.
Validire, J., Imbaud, P., Dutet, D. and Duron, J.J. (1986) Large abdominal incisional hernias: repair by fascial ap-proximation reinforced with a stainless steel mesh. Br J Surg, 73, 8–10.
Bauer, J.J., Harris, M.T., Gorfine, S.R. and Kreel, I. (2002) Rives-Stoppa procedure for repair of large inci-sional hernias: experience with 57 patients. Hernia, 6, 120–123.
Knight, R. and Fenoglio, M.E. (2002) The use of the Kugel mesh in ventral hernia repairs. Am J Surg, 183, 642–645.
McLanahan, D., King, L.T., Weems, C., Novotney, M. and Gibson, K. (1997) Retrorectus prosthetic mesh repair of midline abdominal hernia. Am J Surg, 173, 445–449.
Schumpelick, V., Junge, K., Rosch, R., Klinge, U. and Stumpf, M. (2002) [Retromuscular mesh repair for ven-tral incision hernia in Germany]. Chirurg, 73, 888–894.
Stoppa, R.E. (1989) The treatment of complicated groin and incisional hernias. World J Surg, 13, 545–554.
Temudom, T., Siadati, M. and Sarr, M.G. (1996) Repair of complex giant or recurrent ventral hernias by using tension-free intraparietal prosthetic mesh (Stoppa tech-nique): lessons learned from our initial experience (fifty patients). Surgery, discussion 743–734,120, 738-743;
Toniato, A., Pagetta, C., Bernante, P., Piotto, A. and Pe-lizzo, M.R. (2002) Incisional hernia treatment with pro-gressive pneumoperitoneum and retromuscular prosthetic hernioplasty. Langenbecks Arch Surg, 387, 246–248.
Yaghoobi Notash, A., Yaghoobi Notash, A., Jr., Seied Farshi, J., Ahmadi Amoli, H., Salimi, J. and Mamarabadi, M. (2006) Outcomes of the Rives-Stoppa technique in incisional hernia repair: ten years of experience. Hernia.
LeBlanc, K.A. and Whitaker, J.M. (2002) Management of chronic postoperative pain following incisional hernia repair with Composix mesh: a report of two cases. Her-nia, 6, 194–197.
Rives, J. (1987) Major incisional hernia. In J. P. Chevrel (Ed.), Surgery of the abdominal wall, New York: Springer-Verlag, 116–144.
Luijendijk, R.W., Hop, W.C., van den Tol, M.P., de Lange, D.C., Braaksma, M.M., JN, I.J., Boelhouwer, R. U., de Vries, B.C., Salu, M.K., Wereldsma, J.C., Bruijninckx, C.M. and Jeekel, J.A. (2000) Comparison of suture repair with mesh repair for incisional hernia. N Engl J Med, 343, 392–398.
Itani, K.M., Neumayer, L., Reda, D., Kim, L. and An-thony, T. (2004) Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg, 188, 22S–29S.
Goodney, P.P., Birkmeyer, C.M. and Birkmeyer, J.D. (2002) Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Arch Surg, 137, 1161–165.
Ramirez, O.M., Ruas, E. and Dellon, A.L. (1990) "Com-ponents separation" method for closure of abdomi-nal-wall defects: an anatomic and clinical study. Plast Reconstr urg, 86, 519–526.
Shestak, K.C., Edington, H.J. and Johnson, R.R. (2000) The separation of anatomic components technique for the reconstruction of massive midline abdominal wall de-fects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg, quiz 739, 105, 731–738.
de Vries Reilingh, T.S., van Goor, H., Rosman, C., Be-melmans, M.H., de Jong, D., van Nieuwenhoven, E.J., van Engeland, M.I. and Bleichrodt, R.P. (2003) "Com-ponents separation technique" for the repair of large ab-dominal wall hernias. J Am Coll Surg, 196, 32–37.
Drinkwater, C.J. and Neil, M.J. (1995) Optimal timing of wound drain removal following total joint arthroplasty. J Arthroplasty, 10, 185–189.
Dirschl, D.R., and Wilson, F.C. (1991) Topical antibiotic irrigation in the prophylaxis of operative wound infec-tions in orthopedic surgery. Orthop Clin North Am, 22, 419–426.
O'Connor Jr, L.T. and Goldstein, M. (2002) Topical pe-rioperative antibiotic prophylaxis for minor clean ingui-nal surgery. J Am Coll Surg, 194, 407–410.
Bauer, J.J., Harris, M.T., Kreel, I. and Gelernt, I.M. (1999) Twelve-year experience with expanded polytetra-fluoroethylene in the repair of abdominal wall defects. Mt Sinai J Med, 66, 20–25.
Birolini, C., Utiyama, E.M., Rodrigues Jr., A.J. and Bi-rolini, D. (2000) Elective colonic operation and pros-thetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use? J Am Coll Surg, 191, 366–372.
Leber, P.D. and Davis, C.S. (1998) Threats to the validity of clinical trials employing enrichment strategies for sample selection. Control Clin Trials, 19, 178–187.
Welty, G., Klinge, U., Klosterhalfen, B., Kasperk, R. and Schumpelick, V. (2001) Functional impairment and com-plaints following incisional hernia repair with different polypropylene meshes. Hernia, 5, 142–147.
Sugerman, H.J., Kellum Jr., J.M., Reines, H.D., DeMaria, E.J., Newsome, H.H. and Lowry, J.W. (1996) Greater risk of incisional hernia with morbidly obese than ster-oid-dependent patients and low recurrence with prefas-cial polypropylene mesh. Am J Surg, 171, 80–84.
Balen, E.M., Diez-Caballero, A., Hernandez-Lizoain, J. L., Pardo, F., Torramade, J.R., Regueira, F.M. and Cien-fuegos, J.A. (1998) Repair of ventral hernias with ex-panded polytetrafluoroethylene patch. Br J Surg, 85, 1415–1418.
Adloff, M. and Arnaud, J.P. (1987) Surgical management of large incisional hernias by an intraperitoneal Mersi-lene mesh and an aponeurotic graft. Surg Gynecol Obstet, 165, 204–206.