Rives-stoppa Incisional Hernia Repair Combined with Laparoscopic Separation of Abdominal Wall Components: A Novel Approach to Complex Abdominal Wall Closure

Introduction: The Rives-Stoppa hernia repair is the gold standard for mesh repair of complex incisional hernias. The rate of wound infection can be reduced if fascial closure is achievable between the skin and the prosthetic mesh. For larger defects, fascial closure is not often possible without raising large skin flaps for separation of the abdominal wall components. This can lead to devascularization of the overlying skin and denervation of the abdominal wall musculature. Laparoscopic components separation minimizes these risks while facilitating anterior fascial closure. This combined technique has not previously been reported.
Methods: A retrospective review of patients who underwent Rives-Stoppa incisional hernia repair augmented by laparoscopic components separation was performed.
Results: Five patients were identified. Three patients developed hernias following laparotomy from severe injuries sustained in the Global War on Terror. The other two patients included hernia after esophagectomy and after retroperitoneal liposarcoma resection. Average defect size was 310 cm2. Fascial closure anterior to the mesh was achieved in all but one patient. The residual defect in this patient was reduced from 375 cm2 to 96 cm2. Early post operative complications included a superficial skin infection not involving mesh and a recurrent enterocutaneous fistula. No mortalities occurred and at short term follow-up no incisional hernia recurrences have developed.
Conclusion: Rives-Stoppa repair augmented by laparoscopic components separation is an innovative method for reconstruction of complex abdominal wall defects. Laparoscopic components separation allows fascial closure to be achieved anterior to the mesh in large incisional hernias, which may reduce wound infection rates.

Session: Podium Presentation

Program Number: S127