Repair of large
Abdominal Wall Hernias Using Expanded Abdominal Wall Musculature
Tarek Ahmed Said, M.D
of Surgery, Faculty of Medicine, Cairo University
Egypt. J. Plast. Reconstr. Surg.,
Vol (24), No (1),2000: 71-77
A new technique to deal with hugemidline
anterior abdominal wall hernias is described using expanded anterolateral
abdominal wall muscles and fascia by two tissue expanders placed laterally
in the bloodless plane between the external and internal oblique muscles
through small subcostal incisions lateral to the rectus abdominis muscle.
10 cases of huge midline hernias with a mean defect diameter of 13.5 cms
were operated upon using two 800 cc expanders. Expansion of abdominal wall
musculature was done for a mean period of 50 days and using a mean volume
of 760 cc in each expander. Complications were in the form of bilateral
seroma development in one case (10%) and unilateral infection in another
(5% of expanders) (10% of cases). Both were treated and expansion was completed.
Easy closure of abdominal wall defect was accomplished in all cases with
no significant postoperative respiratory distress. No synthetic mesh was
needed in any case and there were no recurrences on 6 months follow-ups.
This technique provides an excellent choice for huge ventral midline abdominal
wall hernia closure that avoids the use of synthetic mesh with its inherent
hazards of resistant infection that can in some instances necessitate mesh
removal. It avoids the limitations and disadvantages of using extra-abdominal
flaps and moreover can be used as a remedy for complications of other methods
of hernia repair especially infections and recurrence accompanying mesh
hernioplasty. Expansion of abdominal muscles also serves to enlarge the
capacity of abdominal cavity in face of returning hernial contents.