Sliding door technique for the repair of midline incisional hernias

• Published in: Plastic and reconstructive surgery (1963) Vol. 101; no. 5; pp. 1235 - 1242
• Main Authors: KUZBARI, R, WORSEG, A. P, TAIRYCH, G, DEUTINGER, M, KUDERNA, C, METZ, V, ZAUNER-DUNGL, A, HOLLE, J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-04-1998
• Subjects: Abdomen; Abdominal Muscles - diagnostic imaging; Abdominal Muscles - physiology; Abdominal Muscles - surgery; Adult; Aged; Biological and medical sciences; Exudates and Transudates; Fasciotomy; Female; Follow-Up Studies; Hernia, Ventral - diagnostic imaging; Hernia, Ventral - etiology; Hernia, Ventral - physiopathology; Hernia, Ventral - surgery; Humans; Laparotomy - adverse effects; Male; Medical sciences; Middle Aged; Muscle Contraction; Necrosis; Postoperative Complications; Rectus Abdominis - surgery; Recurrence; Skin - pathology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Suture Techniques; Ultrasonography; Human; Wall; Anterior; Abdomen; Result; Hernia; Incision; Autograft; Treatment; Abdominal disease; Surgery; Graft; Complication; Tension; Technique; Laparotomy; Rectus abdominis muscle
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/00006534-199804010-00010

We describe a technique that enables the autologous repair of large midline incisional hernias by restoring the functional musculoaponeurotic support of the abdominal wall. Unlike other methods of hernia repair, the essential step of the sliding door technique is the complete release of the rectus abdominis muscles from the anterior and posterior layers of their sheaths. The released muscles are thus overlapped and sutured together without tension. Another step of the technique is the release of both rectus sheaths by incising the aponeuroses of the external oblique muscles. We report on the use of this technique in 10 patients with midline incisional hernias (mean size of the abdominal musculofascial defect 14 x 11 cm). The patients were examined 14 months to 5.5 years after hernia repair. Two postoperative complications occurred: one marginal skin necrosis and one subcutaneous seroma. Recurrences were not observed. Ultrasound examination showed that the rectus muscles maintained their overlapped position postoperatively. Clinical muscle testing indicated that the strength of the released rectus muscles provides functional support to the reconstructed anterior abdominal wall.