Page 37 - herina surgery and possible lawsuits

Stoppa-Rives giant prosthetic repair
The technique is an important tension-free technique done through an open posterior

approach, recommended for large, complex, or bilateral hernias. It is performed using one of
two standard incisions - a infra umbilical vertical midline or a low horizontal skin incision.
The midline fascial layers are divided, providing access to the preperitoneal space. A large

piece of mesh (Stoppa recommended Dacron) is then prepared in a chevron shape with a
dimension of 24*18 cm. The mesh is then placed into the preperitoneal space using clamps.
No attempt is made to secure the mesh with clips or sutures. The defects in the abdominal

wall are left unsutured. This repair is similar in many ways to the laparoscopic repair, and
familiarity with the anatomy from the “ inside” is helpful when approaching hernias
laparoscopically.[76]

The Cochrane Database Systematic Review is the highest level o f evidence. In 2002
Cochrane retrospective study five randomized controlled trials, 1,51.3008 patients, not
depend on the operative technique and concluded that the implantation of meshes
significantly decreases the overall recurrence rate, the occurrence o f chronic pain and the

time o f return to normal activity, as compared to non-mesh techniques. [77]

43