A new technique for repair of large ventral hernias using the "starburst" mesh closure technique.
Large ventral hernias are extremely difficult surgical problems, especially in the obese population. Any such hernias with diameters greater than 15 cm are especially prone to significant operative morbidity and high recurrence rates. We report a new technique of mesh closure that has resulted in no morbidity and no recurrences in this high-risk population. Seven patients with large ventral hernias (> 15 cm in diameter) have undergone this new procedure. Three patients required a preoperative establishment of a pneumoperitoneum to increase abdominal domain. A piece of Marlex mesh is fashioned with spokes 2 cm x 10 cm radiating from the central area of the mesh. The central area is sewn to the fascia with a running circumferential suture, and the spokes are then brought out from beneath the fascia, extending approximately 7.5 cm from the edge. The spokes are secured to the fascia at their exit points and then are again secured toward the center of the mesh. Over follow-up periods ranging from 6 months to 4 years, no recurrences or infections have occurred in these seven patients.