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Rives' technique for the treatment of incisional hernias consists in the insertion of a synthetic mesh in the space behind the muscolar layer over the posterior fascia of rectus anterior.

The opening of the muscular fascia is really expected on the back face of the muscles, but we prefer the opening of the anterior? face to obtain an easier closing of the breach resulting so a correct isolation of the intestinal anse from the mesh.

Fascia suture is not always possible and the alternative are:

• Discharging incisions in the anterior muscolar fascia.
• Elements scomposition as Ramirez's technique.
• To suture anterior muscolar fascia to the mesh, leaving a little amount? of mesh to contact subcutaneous tissue..

We prefer this third possibility and did not verify drawbacks, if we ensure a good drainage for at least 4 - 5 days.

We illustrate the technique in this case of incisiona hernias? after colostomia for peritonite

Preoperatory wiew :? sopraumbilical hernia of about 15 cm.

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L'Rx clisma opaque shows the engagement of the colon trasverso in the hernia's door.

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Such find is confirmed by the TC.

The hernia's sac is free up to the muscolar fascia.

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We have to perform omentectomia to facilitate the? wall closing.

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We start opening the anterior fascia of the muscles recti.

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We continue opening with the scissors.

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Fascia is opened.

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The fascies are well opened.

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The posterior fascies have? sutured on the middle line with? continuous sutures in riassorbible material.

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The posterior? wall entire rebuilded.

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Put the mesh, in this case a polipropilene/ac. glicolico mesh, we appone the first fixing point ?upwards on the middle line.

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The mesh? comes fixed sideways and in lower part with other transfascial points.

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The anterior fascia? cannot be sutured without tension, so we put?? four continuous suture to fix the prosthesis to the fascia. You can see? like a bit of mesh remains to contact the subcutaneous tissue.

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We put ?three drainages in aspiration.

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The surgical procedure is finished.

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Last update: 09-09-03.

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