Large hernia
Defects of 10 cm or more are often accompanied by the “exit” of a significant part of the organs into the sac and weakening of the entire wall: before the operation, MSCT is performed to assess the volume; for giant hernias, preparation (banding, breathing exercises) is performed. Reduction is achieved by release maneuvers (dissection of the rectus sheaths according to Ramirez, if necessary); a 30x30 cm mesh covers the entire reconstruction. Drains last up to 4–5 days, seroma control is required. The result is a restored abdominal corset and prevention of incarceration; loads after 3 months.
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.
