The intraperitoneal approach to abdominal wall reconstruction provides access to innervated fascia and bone and allows the placement of mesh in a taut configuration. The taut configuration avoids ridges that could injure viscera. Suturing to innervated musculofascial layers allows mesh to serve as a new insertion for contractile muscle, reinforcing the abdominal wall with physical activity.

41 consecutive cases of intraperitoneal mesh reconstruction of complex defects were retrospectively assessed.

Mean followup was 22.5 months (1-117). The average defect size was 272 cm2. Half of all patients had undergone prior attempts at repair. Twelve patients underwent simultaneous bowel, biliary, or urologic procedures or removal of infected mesh without increased incidence of infectious complications.

There was one hernia recurrence and no occurrence of bowel injury or mesh infection. There were 29 complications (13 local wound, 4 bleeding, 3 pulmonary, 3 gastrointestinal, 2 Cdifficile, 4 pain). One patient died of myocardial infarction. The mean time to bowel function was 6.4 days.

Intraperitoneal mesh reconstruction of complex abdominal wall defects results in durable repair with low risk of major complications and can be performed simultaneously with bowel/biliary/urologic procedures. The time to return of bowel function may be longer than with other approaches.