State-of-the-art abdominal wall reconstruction and closure

Open ventral hernia repair is one of the most common operations performed by general surgeons. Appropriate patient selection and preoperative optimization are important to ensure high-quality outcomes and prevent hernia recurrence. Preoperative adjuncts such as the injection of botulinum toxin and progressive preoperative pneumoperitoneum are proven to help achieve fascial closure in patients with hernia defects and/or loss of domain. Operatively, component separation techniques are performed on complex hernias in order to medialize the rectus fascia and achieve a tension-free closure. Other important principles of hernia repair include complete reduction of the hernia sac, wide mesh overlap, and techniques to control seroma and other wound complications. In the setting of contamination, a delayed primary closure of the skin and subcutaneous tissues should be considered to minimize the chance of postoperative wound complications. Ultimately, the aim for hernia surgeons is to mitigate complications and provide a durable repair while improving patient quality of life.

Automated summary

Open ventral hernia repair is a common operation for general surgeons. Patient selection and preoperative optimization are crucial for successful outcomes and prevention of recurrence. Techniques such as botulinum toxin injection and preoperative pneumoperitoneum can aid in achieving fascial closure. Component separation is performed on complex hernias to achieve tension-free closure. Other important principles include hernia sac reduction, wide mesh overlap, and management of complications. Delayed primary closure may be considered in contaminated cases. The goal is to minimize complications and improve patient quality of life.