Average defect
For defects of 5–10 cm, it is important to relieve the tension: the edges of the aponeurosis are mobilized, if necessary, loosening incisions are made, suturing is done with a non-absorbable thread with the correct pitch; a 15x20+ cm mesh covers the seam and old thinned areas. At the same time, multi-chamber and accompanying diastasis are eliminated. Redon drains are removed when the discharge decreases; Seroma in the first weeks is monitored by ultrasound and punctures if necessary. Heaviness - after 2.5–3 months, when the mesh is fully integrated.
Indications
- postoperative ventral hernias of medium and large size with wall deformation;
- hernias with excess skin and scars requiring excision;
- relapses after plastic surgery without mesh;
- cases when laparoscopic access is impractical (extensive scars, risk of anesthesia).
ON LAY technique
In open ON LAY repair, the mesh is placed over the sutured aponeurosis, covering the defect by 5 cm in all directions and fixing it around the perimeter: a technically reliable and reproducible method for medium and large postoperative hernias, allowing simultaneous excision of the scar and excess skin (improving the contour of the abdomen). Mandatory elements are active drainage of the mesh bed and a compression bandage, which reduce the risk of seromas. The choice between ON LAY, sublay and laparoscopic techniques (IPOM, E-TAR - in the “Options and prices” block) is made by the surgeon based on the size of the defect and the condition of the tissues.
