Minimally invasive Rives-Stoppa (MIRS) technique: a technique of retromuscular repair of ventral hernias preserving the posterior rectus sheath.

Abstract

Purpose: Retromuscular techniques of ventral hernia (VH) repair involve division of the posterior rectus sheath, entailing a risk of suture line disruption when the gap is sutured or of abdominal swelling when it is not, or when any type of posterior releasing incision is performed. To prevent these drawbacks, we describe a technique of retromuscular repair preserving the posterior sheath integrity.

Methods: The technique involved periumbilical skin incision, hernia reduction, suture of the orifice, bilateral incision of the anterior rectus sheath close to the midline, approximating the medial borders of these aponeurotic incisions by suture, retrorectus mesh deployment and approximation by suture of both lateral borders of the aponeurotic incisions over the mesh, thanks to anterior releasing incisions. Perioperative data were assessed on 177 consecutive patients and mid-term evaluation was carried out in the first 134 patients who had at least one year follow-up.

Results: The mean hernia diameter was 2.6 cm (1-5), the operation duration was 76.4mn (50-120). Twenty-three (13%) uncomplicated seromas, 10 (5.6%) complicated seromas and 4 (2.3%) hematomas occurred. Introducing a quilting procedure amid the study reduced the incidence of complicated seromas from 9.6 to 2.1% (p = 0.031). On 134 patients with at-least 12 months follow-up, 128 (95.5%) were evaluated at a mean follow-up of 14.7 (12-32) months and 6 (4.5%) were lost to follow-up. There were neither recurrences, nor any case of swollen abdomen.  CONCLUSION: The MIRS technique provides effective repair of small VH and prevents the potential drawbacks linked to the division of the posterior sheath.