Repair of large incisional hernias. A new anatomical technique.

Large upper abdominal incisional hernias have always been a vexing problem to surgeons because of the rigidity of the costal arches. With the increasing longevity of our population and the constant improvement in ways to sustain older patients during operative procedures, incisional hernias, especially of the upper abdominal area, will undoubtedly become more prevalent.A new anatomical procedure for repair, which was used in 16 cases, eliminates the necessity of the use of various prosthetic materials: extrapleural sectioning of the costal cartilages from approximately the seventh to the tenth rib permits the directional pull of the attached musculature to narrow the defect, thus allowing repair of the hernia without tension. The procedure is technically a simple one and postoperative complications are minimal.