Anterior Rectus Sheath Flap Repair for the Treatment of Primary Ventral Hernia

Introduction

We describe a tissue-based repair technique for primary ventral hernia. We use the anterior rectus sheath as a flap from across the opposite side to cover and strengthen the suture repair in patients with small primary ventral hernia.

Patients and Methods

Patients with primary ventral hernias of 1 to 3 cm defect width were included in this series. We created a rectangle-shaped anterior rectus sheath flap (ARS). The ARS flap was rotated medially to cover the closed hernia defect. The patients operated with this technique were evaluated for postoperative pain, surgical site infection, seroma, hematoma, skin necrosis, hospital stay, readmissions, chronic pain, and recurrence.

Results

We studied eight patients (six men and two women), seven of whom had an umbilical hernia and one epigastric hernia. Two patients had chronic liver disease with ascites and infected hernia. One was an obstructed hernia. The mean defect width was 2.1 cm (range 1.2 to 2.5), and the mean operative time was 40 min (range 30–50 min). The mean pain score on a scale of 1 to 10 on postoperative day one was 2 (range 1–3). The median follow-up period was 14 months (range 12–47). In the postoperative period, none of the patients had surgical site infection, seroma, hematoma, skin necrosis, readmission, chronic pain, or recurrence.

Conclusion

The anterior rectus sheath flap repair gives strength to the simple suture closure in patients with small primary ventral hernia. It is suitable for repair when the mesh is not desired. However, further studies are needed to throw more light on this promising technique.