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Rives Stoppa Hernia Repair in the Management of Complex Abdominal Wall Hernias
*Daniel Hetherman, Richard Perugini, Donald Czerniach
University of Massachusetts Medical School, Worcester, MA

Objective(s): Evaluation of Rives Stoppa Repair for abdominal wall hernias
Design: Single Institution Case Series
Setting: Academic Tertiary Care Center
Patients: Patients had large complex abdominal wall hernias. Patients were selected for Rives Stoppa repair by surgeon preference. Twenty-eight patients underwent repair.
Interventions: Patients underwent abdominal exploration, adhesiolysis and ventral hernia repair. A retrorectus mesh placed in a Rives Stoppa technique with or without a component separation. Additional abdominal operations, including colostomy reversal and panniculectomy were performed simultaneously in several cases.
Main Outcome Measure(s): Early Perioperative Results of Rives Stoppa Repair
Results: 28 individuals underwent Rives-Stoppa repair of incisional hernia, 50% were male, and 21 (75%) had simultaneous component separation. Mean age was 51 (31-71) and mean BMI was 34 (20-71), with 5 individuals (18%) having BMI > 40 kg/m2. 29% had recurrent hernias, 25% of patients were diabetic, 14% were actively smoking and 25% had a history of heart or vascular disease. The 30-day complication rate was 29%. There was one mortality in the series and two reoperations, one for a missed enterotomy and another for an intra-abdominal collection. Two patients required ICU admission and re-intubation (For atrial fibrillation and residual effects of general anesthesia). Additional complications were superficial wound infections (5/28) requiring drainage. Average length of stay was 5.2 days (1-33). 4 (14%) patients had recurrences of their hernias.
Conclusions: Rives Stoppa hernia repair for complex abdominal wall hernias provides an excellent rate of repair. This repair appears to carry the risks of a major abdominal operation, with wound infection the most common complication. The repair is efficacious over a wide range of BMI, and is well tolerated by individuals with significant comorbidities.


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