Open retrofascial incisional hernia repair is a safe and effective operation.

Background: Incisional hernias occur in about ten percent of patient after elective abdominal operations. Although over 100,000 are performed annually in this country, the best method of repair remains controversial. We report the outcomes after a standardized approach by one surgeon.

Methods: The operation consisted of placement of polypropylene mesh beneath the fascia with fascial closure. A prospective database was maintained for the time period January, 1995, to June, 2014. All patients were followed for a minimum of six months postoperatively.

Results: There were 538 patients with a mean body mass index of 36.2 kg/m(2) and a mean defect size of 134.5 cm(2). There were 292 primary hernias with a recurrence rate of 2.7% and 246 recurrent hernias with a recurrence rate of 4.1% (P = .47). There was one death (.2%). Forty-three patients (8.0%) developed a wound complication, of which 17 (3.2%) were infections and the rest seromas. Only two patients required removal of the mesh. There were six patients admitted for postoperative small bowel obstruction, but only one in the immediate postoperative period. There were two enterocutaneous fistulas, both of which resolved nonoperatively. Five patients developed nonfatal pulmonary emboli. Mean length of stay decreased from an average of 4.0 days for the first 100 patients to 2.8 days for the subsequent patients.

Conclusions: Retrofascial mesh repair for ventral incisional hernias has both low complication and recurrence rate. It should be considered the gold standard for such repairs.