Pathologies Associated with Incisional Hernia: Timing of Intervention

The treatment of concomitant endo-abdominal pathologies at the same time as incisional hernia repair remains a subject of controversy in surgical practice. In recent years, treatment of incisional hernias, especially very large ones, has consisted exclusively of prosthetic mesh repair. While initially mesh repair was used only in selected cases, it has since become the gold standard in treating this pathology, due to technological innovations and the increased experience of surgeons carrying out this procedure [1]. Since the early 1980s, the work of French, American and Italian surgeons has demonstrated the efficiency and feasibility of prosthetic mesh repair [2–4]. New, increasingly sophisticated prostheses are being introduced almost on a daily basis; however, rejection and infection of the mesh remain the most threatening complication that surgeons must consider. For this reason, the well-respected schools of abdominal-wall surgery of Stoppa and Rives have always issued vigorous precautions regarding the uses of prosthetic meshes for specific indications [5]. In this context, until the 1980s, the treatment of concomitant pathologies was absolutely contraindicated, as it was considered to interfere with incisional hernia repair. Nevertheless, Stoppa and Rives have allowed that certain concomitant procedures and pathologies can be managed during mesh repair without a high risk of mesh infection [6].