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The reparation of incisional hernias? is made by numerous techniques, using? in the greater part of the cases synthetic mesh.

Nevertheless the closing of the muscular fascias? is not always possible, so we can leave part of the mesh in the sottocutaneous? (like lately we do) or runs back to the technique of the separation of the components proposal by Ramirez and used in predominance from the Plastic Surgeons.

Such technique expects the separation of the muscular components of the lateral abdominal wall , by longitudinal incision? to insertion of the anterior rectus fascia with the oblique.

In this way the muscles anterior recti? are able to be neared? for some centimeters for side, until to reduce considerable the loss of substance of the abdominal wall, whose reparation we complete with insertion? of a mesh?? underfascial retromuscolar.

The advantage is to cover entirely the prosthesis and to rebuild? anatomically the abdominal wall . We need? a big lateral dissection? of the cute and of the sottocute, that will be able to hesitate in an increase of the incidence of seromas and hematomas.

We pu the mesh? like in the Rives' technique, and the drainage have to be under the anterior fascia and? in the subcutaneous, better one if doubled.

We prepare the hernia . We are? liberating the hernia's sac? and you can see themselves the margins of the breach.

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Diagram of the intervention and lying of the mesh.

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We carved the fascia of the anterior retti? to the level of the advertisement with the external oblique , agreeing the medial nearing ?of the anterior muscles.

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We put the mesh? under? the anterior retti fascia up to the sutured posterior fascia, like in the ?Rives' technique.

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So we can suture? the anterior fascia on the middle line, covering entire the mesh.

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We put two drainages under the fascia up to? the mesh and two drainages in the sottocutaneous, to anticipate the formation of seromas and hematomas.

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Last update: 09-09-03.

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