[Full-thickness replacement using intraperitoneal mesh in large incisional hernia].

Parieto-suture (simple closure or Judd-Mayo technique) is appropriate for most incisional hernias, but not in case of large or complex parietal defect. In these peculiar cases, prosthesis mesh is recommended, biased by two factors: biodisponibility of the material related to the choice of parietal insertion. In practice, fascial onlay is abandoned in favour of extra/retro-muscular onlay, which offers a better vascular support for mesh implantation and is ideal if anatomic closure is feasible. Occasionally, full-thickness replacement is a must in large incisional hernia, in order to restore parietal competence. Technically, substitution is easy to perform, followed by a low rate of in-hospital complications; the same is true if recurrence occurs. In exchange, the hazard of enterocutaneous fistula requires appropriate measures for visceral protection. Our commentary regarding the advantages and disadvantages of intraperitoneal (pro-epiploic) mesh placement, as well as technical details, are based on 10 years of surgical practice.