For primary repair, recurrence rates range from 24% to 54%, with seemingly high recurrence rates after mesh (24%) and suture (43%) repairs. Although mesh repairs have led to improved recurrence rates overall, synthetic mesh repair is associated with various morbidities.
In other words, midline hernias can be of various sizes, and patients differ in age, weight, tissue quality, wounds, and the need for concurrent bowel surgery.
For the abdominal wall, despite the lateral releases, the midline repair fails after primary closure of the hernia in 22.5% of cases, independent of whether the repair is performed in a contaminated field.
Heavyweight polypropylene mesh was used in the early years of the study but was abandoned due to the stiff feel of the prosthetic material rather than to a specific postoperative finding…..In 2004, consecutive patients had their midline repair augmented with cadaveric dermis with the idea that even if the dermis was not long-lasting, its presence could shield and protect the repair in the early stages of healing. In fact, just the opposite was found: the hernia recurrence rate with a cadaveric dermis underlay was even higher than that for primary closure. …..Continued dissatisfaction with hernia recurrences after components separation, seen with primary repair and cadaveric dermis, led to the subsequent use of soft midweight polypropylene mesh for augmentation of the strength of the midline closure. At mean follow-up of 13.8 months, no patient who has undergone a components separation procedure using intra-abdominal soft polypropylene mesh in this series has required a revision. ……